Get the free CONCUSSION MANAGEMENT PROTOCOL ADDENDUM A - middletowncityschools

CONCUSSION MANAGEMENT PROTOCOL ADDENDUM C1 Annual Athletic Participation Health History Questionnaire Students Name: Date of Birth: / / Sex: M F (circle one) Age: School: Grade: District: Sport(s):

How to fill out concussion management protocol addendum

How to fill out concussion management protocol addendum:

1. Start by reviewing the concussion management protocol addendum document thoroughly. Make sure you understand the purpose and requirements of the addendum.
2. Gather all the necessary information and documentation needed to complete the addendum. This may include the original concussion management protocol, any medical records or reports related to the specific concussion case, and any other relevant information.
3. Begin filling out the addendum by entering the required demographic information. This typically includes the name, date of birth, contact details, and any relevant identification numbers for the individual who suffered the concussion.
4. Provide a detailed description of the concussion incident, including the date, location, and circumstances surrounding the injury. Be as specific as possible to ensure accurate recordkeeping.
5. In the addendum, outline any symptoms or complaints reported by the individual since the concussion occurred. This may include physical symptoms like headaches or dizziness, as well as cognitive or emotional symptoms like memory loss or mood changes.
6. Detail any medical evaluations or treatments that have been conducted following the concussion. This may include visits to healthcare providers, diagnostic tests, medications prescribed, or rehabilitation programs recommended.
7. If applicable, document any changes to the individual's academic or work performance that are believed to be related to the concussion. This could involve difficulties in concentration, memory, or other cognitive functions.
8. Include any recommendations or accommodations that have been made to support the individual's recovery and ensure their safety. This may involve adjustments in academic or work settings, limitations on physical activities, or modifications to their daily routines.
9. If there are any additional notes or comments that are relevant to the concussion case, ensure to include them in the appropriate section of the addendum.
10. Finally, review the completed concussion management protocol addendum to ensure accuracy and completeness. Make any necessary corrections or revisions before submitting or sharing the document with the appropriate parties.

Who needs concussion management protocol addendum:

The concussion management protocol addendum is typically required for individuals who have experienced a concussion and are undergoing medical evaluation and treatment. It is a crucial document that helps healthcare providers, schools, employers, and other relevant parties to understand the impact of the concussion, provide appropriate support and accommodations, and monitor the individual's progress towards recovery. The need for a concussion management protocol addendum may arise in various settings such as sports organizations, educational institutions, workplaces, and healthcare facilities.

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What is concussion management protocol addendum?

Concussion management protocol addendum outlines the additional steps and procedures to be followed in the event of a concussion.

Who is required to file concussion management protocol addendum?

Schools, sports organizations, and healthcare providers are required to file concussion management protocol addendum.

How to fill out concussion management protocol addendum?

Concussion management protocol addendum can be filled out by providing detailed information on concussion policies, procedures, and contact information.

What is the purpose of concussion management protocol addendum?

The purpose of concussion management protocol addendum is to ensure that proper steps are taken in managing concussions and ensuring the safety of individuals.

What information must be reported on concussion management protocol addendum?

Information such as concussion policies, procedures, emergency contacts, and return-to-play protocols must be reported on concussion management protocol addendum.

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