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REVIEW OF CONCUSSION EVALUATION CARE PLAN DATE UPDATED Student Name Date of Injury: Physician: Physician Phone Number: Returning to School The following supports are recommended: (check all that apply)

How to fill out review of concussion evaluation

How to fill out a review of concussion evaluation:

1. Obtain the necessary forms: Begin by obtaining the specific review of concussion evaluation form from a healthcare provider or the organization requesting the review. This form typically includes sections for personal information, medical history, concussion symptoms, and evaluation outcomes.
2. Fill in personal information: Start by providing your personal details such as full name, date of birth, contact information, and any relevant identification numbers.
3. Provide medical history: In this section, you will be asked to provide information about any previous concussions or head injuries you have experienced. Include details such as the dates of the injuries, symptoms experienced, and any medical treatment you received.
4. Describe current concussion symptoms: This section requires you to detail any symptoms you are currently experiencing as a result of the concussion. Symptoms may include headaches, dizziness, memory problems, sensitivity to light or noise, difficulty concentrating, and mood changes, among others. Be as specific and detailed as possible to aid the healthcare provider in accurately assessing your condition.
5. Report evaluation outcomes: If you have undergone any specific evaluation tests or assessments related to the concussion, such as neurocognitive testing or balance assessments, provide the results in this section. Include any additional information provided by the evaluating healthcare provider that may be relevant to the review.

Who needs a review of concussion evaluation?

1. Athletes: Athletes who have suffered a concussion during sports activities may require a review of concussion evaluation. This review is often necessary before they are cleared to return to play to ensure their safety and monitor their recovery progress.
2. Students: Students who have sustained a concussion may need a review of concussion evaluation to determine any necessary accommodations for their academic environment. This allows the school to understand their needs and provide appropriate support during the recovery period.
3. Workplace employees: Employees who have suffered a concussion while on the job may require a review of concussion evaluation. This helps employers determine if any modifications or accommodations are necessary to ensure a safe working environment and promote the employee's recovery.

It is crucial to consult with a healthcare professional to determine if a review of concussion evaluation is needed in your specific case, as requirements may vary based on individual circumstances and regulations.

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What is review of concussion evaluation?

The review of concussion evaluation is a process where a medical professional assesses and evaluates a person who may have suffered a concussion to determine the severity of the injury and provide appropriate treatment and management.

Who is required to file review of concussion evaluation?

Any individual who has suffered a concussion or is suspected of having a concussion is required to undergo a review of concussion evaluation by a qualified medical professional.

How to fill out review of concussion evaluation?

The review of concussion evaluation is filled out by a medical professional who will document the individual's symptoms, medical history, physical exam findings, and any relevant test results to determine the presence and severity of a concussion.

What is the purpose of review of concussion evaluation?

The purpose of the review of concussion evaluation is to accurately diagnose and assess the severity of a concussion, provide appropriate treatment and management, and monitor the individual's progress and recovery.

What information must be reported on review of concussion evaluation?

The review of concussion evaluation must include the individual's symptoms, medical history, physical exam findings, any test results, treatment recommendations, and a follow-up plan.