Get the free concussion declaration form

UNIVERSITY OF PORTLAND SPORTS MEDICINE CONCUSSION DECLARATION OF SYMPTOMS ACKNOWLEDGEMENT FORM I, have read the University of Portland Sports Medicine Department s policy on concussions and concussion

How to fill out concussion declaration form

1. To fill out a concussion declaration form, start by obtaining the form from your school, employer, or athletic organization. They will typically provide you with a physical copy or a link to an online version of the form.
2. Carefully read through the form and instructions provided. Familiarize yourself with the purpose of the form and the information it requires. This will help ensure that you provide accurate and complete information.
3. Begin by filling out your personal information section. This may include your full name, date of birth, address, contact information, and any other required details. Make sure to write legibly and double-check for any possible mistakes.
4. Next, you may be asked to provide information about your current or previous medical conditions, including any history of concussions or head injuries. Be honest and provide as much detail as possible, as this will help healthcare professionals accurately assess your condition if needed.
5. Some forms may also ask about any medications you are currently taking. Provide the names, dosages, and frequency of use for any relevant medications. If you're unsure about any specific medications, consult with your healthcare provider before completing this section of the form.
6. In some cases, you may need to answer additional questions regarding your symptoms, any recent head injuries, or activities that may have contributed to the concussion risk. Take your time to answer these questions accurately, as they are crucial for healthcare providers to have a complete understanding of your situation.
7. If the form includes a section for parent/guardian signature (typically for minors), ensure that this section is completed by the appropriate individual. This verifies that the information provided is accurate and that consent is given for any required medical care.
8. Once you have completed all the required sections and double-checked for any errors or omissions, sign the form using your legal signature. By signing, you acknowledge that the information you have provided is true and accurate to the best of your knowledge.
9. Keep a copy of the completed form for your records and submit the original to the designated recipient or organization. Make sure to follow any additional instructions provided, such as mailing or hand-delivering the form.

Who needs a concussion declaration form may vary depending on the specific context. However, generally, individuals who participate in activities with a higher risk of head injuries, such as athletes, students involved in organized sports, or employees in physically demanding jobs, may be required to complete a concussion declaration form. This form helps ensure that appropriate precautions are taken if a concussion occurs and provides valuable information for medical professionals in case of an injury. Check with the relevant organization or authority to determine if you need to fill out a concussion declaration form.

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What is concussion declaration form?

A concussion declaration form is a document used to report any concussions or head injuries that occur during sports activities or events.

Who is required to file concussion declaration form?

Coaches, athletes, and medical personnel are typically required to file a concussion declaration form when a concussion or head injury is suspected or diagnosed.

How to fill out concussion declaration form?

To fill out a concussion declaration form, individuals must provide detailed information about the injury, including symptoms, date of occurrence, and any medical treatment received.

What is the purpose of concussion declaration form?

The purpose of the concussion declaration form is to ensure that proper protocol is followed for the management and treatment of concussions, and to protect the health and safety of athletes.

What information must be reported on concussion declaration form?

Information that must be reported on a concussion declaration form includes details about the injury, symptoms, date of occurrence, medical treatment, and clearance to return to play.