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Oct 17, 2012 ... Document created 7×1/2011. A concussion is a brain injury and all brain injuries are serious. They are ...
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How to fill out concussion information sheet
How to Fill out a Concussion Information Sheet:
01
Start by writing your personal information: Fill in your full name, date of birth, address, phone number, and email address. This information is crucial for identification purposes.
02
Provide emergency contact details: Include the name, relationship, and phone number of at least one emergency contact person. This person should be someone who can be reached promptly in case of an emergency.
03
Record your medical history: Write down any pre-existing medical conditions, allergies, or medications that you are currently taking. This information helps healthcare professionals assess your overall health and make informed decisions.
04
Describe the nature of your concussion: Indicate how and when the concussion occurred. Specify the activity or incident that led to the injury and provide the date and time. This information assists in understanding the specific circumstances surrounding the concussion.
05
Document your symptoms: List any symptoms you are experiencing as a result of the concussion, such as headaches, dizziness, nausea, memory loss, sensitivity to light, or difficulty concentrating. Be as detailed as possible, as this will aid in the diagnosis and treatment process.
06
Describe the initial response to the concussion: Note any immediate steps taken after the injury, such as first aid administered, medical professionals consulted, or hospital visits. This information helps in evaluating the initial management of the concussion.
07
Provide information about your previous concussions: If you have had any previous concussions, indicate the number of concussions experienced, the approximate dates, and any medical treatment you received. Previous concussions can impact the severity and management of your current concussion.
08
Sign and date the form: After completing all the required sections, carefully read through the information provided and ensure its accuracy. Sign and date the concussion information sheet to confirm that all the information is true and correct to the best of your knowledge.
Who Needs a Concussion Information Sheet?
Anyone who has experienced a concussion or suspects they may have a concussion should complete a concussion information sheet. This includes athletes, individuals involved in accidents or falls, or anyone who has had a blow to the head. The information collected on the sheet helps healthcare professionals assess the severity of the concussion, determine appropriate treatment plans, and monitor the patient's progress. It is essential to provide accurate and comprehensive information to ensure optimal care and recovery.
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What is concussion information sheet?
Concussion information sheet is a document that provides details about a concussion, including symptoms, treatment, and recovery.
Who is required to file concussion information sheet?
Coaches, trainers, and healthcare providers are required to file the concussion information sheet.
How to fill out concussion information sheet?
To fill out the concussion information sheet, you need to provide details about the individual who suffered the concussion, the date of the injury, symptoms experienced, treatment received, and any follow-up care.
What is the purpose of concussion information sheet?
The purpose of the concussion information sheet is to ensure that proper care and follow-up measures are taken for individuals who have suffered a concussion.
What information must be reported on a concussion information sheet?
The information that must be reported on a concussion information sheet includes details about the individual who suffered the concussion, symptoms experienced, treatment received, and any follow-up care.
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