20. The health assessment in support of an application for a lump sum must, in particular, contain the following information:(1) the name and contact information of the person who is a victim;
(2) the file number assigned by the Minister, if any;
(3) the date or period in which the criminal offence was committed;
(4) the contact information for the health professional who carries out the assessment;
(5) the supplier number assigned to the health professional by the Minister, if any;
(6) the diagnosis, the diagnostic impression or a description of the injury;
(7) the state of health of the person who is a victim at the end of the assessment;
(8) the degree to which the therapeutic objectives have been achieved and the progress made by the person who is a victim;
(9) any relevant antecedent concerning the impairment;
(10) any medication prescribed or any other therapeutic measure prescribed or required;
(11) any examination conducted;
(12) any functional limitation resulting from the injury;
(13) any esthetic change resulting from the injury;
(14) any permanent sequela resulting from the injury, including the nature and intensity of the injury.