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MM/DD/YYYY) (End Date: MM/DD/YYYY) (If Specific Injury, use the start date as the specific date of injury) Body Part 1: Body Part 3: Body Part 2: Body Part 4: Other Body Parts: Specific Injury Case Number 14 Cumulative Injury (Start Date: MM/DD/YYYY) (End Date: MM/DD/YYYY) (If Specific Injury, use the start date as the specific date of injury) Body Part 1: Body Part 3: Body Part 2: Body Part 4: Other Body Parts: DWC-CA form 10232.1 Rev. 10/2008- Page 5 of 8 Specific Injury Ca.

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