Get the free Concussion Information Sheet - d118org

... Illinois 60084-1299, (847) 526-7690, Fax (847) 526-1019, www.d118.org. Dr. Daniel J. Cole's. Wanda Grade Robert Crown Cotton Creek Wanda Middle Matthews Middle Wanda High ...... Head injury/Concussion/Passed

How to fill out concussion information sheet

How to Fill Out a Concussion Information Sheet:

1. Collect the necessary personal information: Begin by filling out your personal details such as your name, date of birth, address, and contact information. This is important for identification and communication purposes.
2. Provide medical history: The concussion information sheet will likely ask for your medical history, including any previous head injuries or concussions. Be sure to accurately disclose any relevant information to ensure proper evaluation and treatment.
3. Answer symptom-related questions: The sheet may include a series of questions about your current symptoms or any symptoms you have experienced in the past. These questions help medical professionals understand the severity of your injury and guide the treatment plan.
4. Document current symptoms: If you are experiencing any symptoms at the time of filling out the sheet, such as headaches, dizziness, or memory loss, be sure to include them. This will assist healthcare providers in assessing your condition and providing appropriate care.
5. Describe the incident: The concussion information sheet might ask for a detailed account of how the injury occurred. Include information such as the date, time, location, and any other relevant details that could help with diagnosis and treatment.
6. Sign and date the sheet: Once you have completed all the necessary sections, ensure you sign and date the document. By signing, you acknowledge that the information provided is accurate to the best of your knowledge.

Who Needs a Concussion Information Sheet?

1. Athletes: Individuals participating in sports, especially contact sports like football, rugby, or soccer, should have a concussion information sheet on file. This helps coaches, trainers, and medical professionals better understand an athlete's history and symptoms in case of a head injury.
2. Students: Schools and educational institutions often require students to fill out concussion information sheets, especially before participating in physical education classes or organized sports activities. This enables teachers and school nurses to respond appropriately if a concussion occurs during school hours.
3. Employees: In certain industries where head injuries are more likely, such as construction or manufacturing, employers may request employees to complete a concussion information sheet. This is to ensure prompt medical attention can be provided if an injury occurs at the workplace.
4. Recreational participants: Anyone engaging in recreational activities like cycling, skateboarding, or skiing should consider filling out a concussion information sheet. Being prepared allows for quicker diagnosis and treatment should an accident involving head trauma occur.

Remember, each organization or institution may have its specific requirements concerning concussion information sheets. It is essential to comply with the instructions and fill out the sheet accurately to obtain proper care in case of a concussion.

For pdfFiller’s FAQs

What is concussion information sheet?

Concussion information sheet provides information about signs and symptoms of concussion, as well as guidelines for recovery and return to play.

Who is required to file concussion information sheet?

Coaches, trainers, and administrators of youth sports organizations are required to file concussion information sheet.

How to fill out concussion information sheet?

Concussion information sheet can be filled out by providing relevant information about the athlete, details of the injury, and steps taken for recovery.

What is the purpose of concussion information sheet?

The purpose of concussion information sheet is to ensure that proper protocols are followed in case of a suspected concussion, and to promote awareness and education about concussions.

What information must be reported on concussion information sheet?

Information such as athlete's name, age, date of injury, symptoms experienced, and medical treatment received must be reported on concussion information sheet.

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