DATE OF INJURY : October 4, 2000,DATE OF EXAMINATION : September 5, 2003,EXAMINING PHYSICIAN : X Y, MD,Prior to the beginning of the examination, it is explained to the examinee that this examination is intended for evaluative purposes only, and that it is not intended to constitute a general medical examination. 
DATE OF INJURY : October 4 , 2000,DATE OF EXAMINATION : September 5 , 2003,EXAMINING PHYSICIAN : X Y , MD , Prior to the beginning of the examination , it is explained to the examinee that this examination is intended for evaluative purposes only , and that it is not intended to constitute a general medical examination .