[
    {
        "page": 1,
        "items": [
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 166.8,
                    "t": 761.52,
                    "r": 434.64,
                    "b": 716.88
                },
                "text": "HANCOCK COUNTY INJURY REPORT\n(NON-EM PLOYEE)",
                "reading_order": 0,
                "level": 1
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 165.6,
                    "t": 712.08,
                    "r": 435.12,
                    "b": 697.92
                },
                "text": "(Forward Completed Form to hancock-hr@hancockin.gov)",
                "reading_order": 1
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 33.36,
                    "t": 669.84,
                    "r": 291.84,
                    "b": 652.32
                },
                "text": "DATE: ___",
                "reading_order": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 33.36,
                    "t": 638.16,
                    "r": 291.84,
                    "b": 619.68
                },
                "text": "NAME: ___",
                "reading_order": 3
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 32.88,
                    "t": 604.32,
                    "r": 541.2,
                    "b": 556.08
                },
                "text": "ADDRESS: ___",
                "reading_order": 4
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 34.08,
                    "t": 543.12,
                    "r": 542.88,
                    "b": 524.88
                },
                "text": "FORM COMPLETED BY: ___",
                "reading_order": 5
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 32.88,
                    "t": 509.52,
                    "r": 542.88,
                    "b": 433.2
                },
                "text": "LOCATION OF INJURY/ ACCIDENT:",
                "reading_order": 6
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 32.64,
                    "t": 418.8,
                    "r": 580.56,
                    "b": 243.36
                },
                "text": "DESCRIPTION OF ACCIDENT/ INJURY:",
                "reading_order": 7
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 33.6,
                    "t": 235.92,
                    "r": 577.68,
                    "b": 193.2
                },
                "text": "TYPE OF INJURY:",
                "reading_order": 8
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 33.84,
                    "t": 187.2,
                    "r": 577.68,
                    "b": 144.48
                },
                "text": "WITNESS(ES) TO ACCIDENT:",
                "reading_order": 9
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 33.84,
                    "t": 136.8,
                    "r": 578.4,
                    "b": 96
                },
                "text": "COMMENTS:",
                "reading_order": 10
            }
        ]
    }
]