This government document is issued by Maryland National Guard for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:zltrvnzn7hc&q=https://military.maryland.gov/Documents/Accident%25202%2520When%2520an%2520Injury%2520Occurs%2520Form.pdf&sa=U&ved=2ahUKEwjb_8al3onxAhUOuKQKHWhnBso4ChAWMAR6BAgEEAE&usg=AOvVaw0tYe-_JUZcw_9VVWEk03YH