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Medical Examiners Reporting Form
Please include any information that you feel comfortable sharing. For safety, fill out form on personal computer/device instead of county computers. All reports are confidential.
If you have questions or prefer to report via email, please contact
Date of Issue
Describe the Issue / Circumstance of Concern
Describe possible remedy or solution you would like to explore
Would you like to be contacted?
No follow up needed at this time.
Phone Number (optional; to be used for texting to arrange meeting)
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