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Prospect High School Athletic Training Date: 801 W. Kensington Rd. Mt. Prospect, IL 60056 PHONE: 8477185403 FAX: 8477185404 Katie Cotton, MAT, ATC Aaron Mainstay, MS, ATC Alisa Mastrodomenico, ATC

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How to fill out concussion follow-up form

How to fill out a concussion follow-up form?

01

Begin by carefully reading the instructions provided on the form. This will help you understand the requirements and gather the necessary information.

02

Start with the personal information section. Fill in your full name, date of birth, address, and contact details. Ensure the accuracy of the information to avoid any misunderstandings or delays.

03

Move on to the medical history section. Provide details about any previous concussions or head injuries you have experienced. Include the dates, symptoms, and any medical treatments received.

04

Provide information about your current symptoms and their severity. Be specific and descriptive, mentioning any physical, cognitive, or emotional changes you have noticed since the injury.

05

If you have sought medical attention, provide details about the healthcare professional you have seen, including their name, specialty, and contact information. Include any diagnostic tests conducted and the results, if available.

06

Describe any ongoing treatments or therapies you are receiving for your concussion, such as physical therapy, cognitive rehabilitation, or counseling. Include the names of the healthcare providers involved, their contact information, and the frequency of the treatments.

07

If applicable, indicate whether you have missed any school or work due to your concussion. Provide the dates and any supporting documentation, such as medical certificates or school absence records.

08

Finally, read through your completed form to ensure accuracy and completeness. Make any necessary corrections or additions before signing and dating the form.

Who needs a concussion follow-up form?

01

Athletes: Athletes who have experienced a concussion during sports activities may be required to fill out a follow-up form as part of their injury management protocol. This helps healthcare providers monitor their progress and make informed decisions regarding their return to play.

02

Students: Students who have suffered a concussion may need to complete a follow-up form for their school or university. This allows educators and administrators to understand the impact of the injury on their academic performance and provide appropriate accommodations if needed.

03

Employees: In some cases, employees who have experienced a concussion at work may be required to fill out a concussion follow-up form. This helps employers ensure that their staff receives appropriate support and accommodations to aid in their recovery and minimize any work-related risks.

It is important to note that the specific requirements for a concussion follow-up form may vary depending on the organization or healthcare provider. Always follow the instructions provided and consult with a healthcare professional if you have any questions or concerns regarding the form or your condition.

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What is concussion follow-up form?

Concussion follow-up form is a document used to track the progress of an individual who has suffered a concussion.

Who is required to file concussion follow-up form?

Athletes, coaches, and medical professionals are required to file the concussion follow-up form.

How to fill out concussion follow-up form?

The concussion follow-up form should be filled out with information regarding the individual's symptoms, treatment plan, and progress.

What is the purpose of concussion follow-up form?

The purpose of the concussion follow-up form is to ensure that individuals who have suffered concussions receive proper care and monitoring.

What information must be reported on concussion follow-up form?

Information such as symptoms, treatment plan, progress, and any changes in condition must be reported on the concussion follow-up form.

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