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Office use only: Date: Exam Room: Moderator: Alt.ID# Baseline Worksheet I. General Information Demographic and Background Information Name DOB SS# Height Weight School/ Organization Handedness: R
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How to fill out upmc concussion program

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How to fill out the UPMC Concussion Program:

01
Visit the official UPMC website and navigate to the Concussion Program section.
02
Review the program details and requirements to ensure it aligns with your needs.
03
Click on the "Fill Out Form" or similar button to start the program enrollment process.
04
Provide your personal details, including your name, contact information, and date of birth.
05
Answer all the questions related to your concussion history, symptoms, and previous medical treatment.
06
If applicable, provide information about the healthcare professional who diagnosed your concussion.
07
Carefully read and understand the terms and conditions of the program enrolment.
08
Check the appropriate box to indicate your agreement to the program terms and conditions.
09
Once all required fields are completed, submit the form electronically.
10
After submitting the form, you may receive a confirmation email or message with further instructions or next steps.

Who needs the UPMC Concussion Program:

01
Athletes who have experienced a concussion during sports activities.
02
Individuals who have suffered a head injury or blow to the head.
03
Anyone who exhibits symptoms of a concussion, such as headaches, dizziness, memory problems, or difficulty concentrating.
04
Parents or guardians of children who have sustained a head injury and are seeking proper concussion management.
05
Healthcare professionals or coaches who require educational resources and guidelines for managing concussions.
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The UPMC concussion program is a comprehensive program designed to help diagnose, treat, and manage concussions.
Athletes, coaches, and medical personnel are required to file the UPMC concussion program.
The UPMC concussion program can be filled out online or in person with the guidance of medical professionals.
The purpose of the UPMC concussion program is to ensure that concussions are properly diagnosed and treated to prevent long-term damage.
Information such as the date of injury, symptoms, and treatment plan must be reported on the UPMC concussion program.
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