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CONCUSSION EVALUATION AND RELEASE TO PLAY FORM SECTION ONE: Completed by School Personnel Student Name: Date: Grade: Sports Team: Number of Past Concussions: Brief Description by School Personnel

How to fill out concussion evaluation and release

How to fill out concussion evaluation and release:

1. Obtain the necessary forms: Start by obtaining the concussion evaluation and release forms from a healthcare provider, school, or sports organization. These forms are typically used to assess and document symptoms, as well as to release an individual from medical care.
2. Read and understand the forms: Take the time to carefully read and understand the information provided in the evaluation and release forms. Familiarize yourself with the purpose of each section and the instructions for completing them.
3. Personal information: Begin by filling out your personal information accurately and completely. This may include your name, date of birth, address, contact information, and any other requested details. Ensure that all information is legible and up to date.
4. History and symptoms: The forms will typically include sections that ask about your concussion history, if any, as well as any previous symptoms or medical conditions that may be relevant. Be honest and thorough in providing this information, as it helps in accurate evaluation and treatment.
5. Description of incident: Describe in detail how the concussion occurred, including the date, time, location, and any relevant circumstances. Include information about any witnesses present during the incident.
6. Symptoms and severity: Use the symptom checklist provided in the evaluation form to identify and document any symptoms you are experiencing following the concussion. Indicate the severity of each symptom, such as mild, moderate, or severe, to give healthcare providers a better understanding of your condition.
7. Medical treatment and recovery: Provide information about any medical treatment received for the concussion, such as visits to healthcare professionals, medication, or recommended rest and recovery protocols. Include information about any ongoing symptoms or changes in symptoms since the time of the incident.
8. Signature and consent: Once you have completed all the necessary sections, review the forms for accuracy and completeness. Then, sign and date the evaluation and release forms, indicating your consent for the information provided and acknowledging that you have truthfully completed the forms to the best of your knowledge.

Who needs concussion evaluation and release:

1. Athletes: Athletes of all ages and levels who participate in contact sports or activities that carry a risk of head injuries may need to undergo a concussion evaluation and release. This is to ensure their safety and confirm their readiness to return to sport after a concussion.
2. Students: Students who sustain a head injury during school hours or while participating in school-related activities also require a concussion evaluation and release. This is to ensure they can safely return to their academic and extracurricular activities without compromising their health.
3. Employees: Depending on the nature of their work, employees who experience a head injury on the job may need to undergo a concussion evaluation and release before being cleared to resume their duties. This is to ensure workplace safety and mitigate any potential risks.
4. Recreation and activity participants: Individuals involved in recreational sports, outdoor activities, or other physical pursuits that may lead to head injuries should consider getting a concussion evaluation and release. This allows for a comprehensive assessment of their condition and ensures that they can participate safely in future activities.

Note: It is important to consult with a healthcare professional or follow the guidelines provided by your school, employer, or sports organization to determine whether you specifically need a concussion evaluation and release.

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What is concussion evaluation and release?

Concussion evaluation and release is a process where individuals who have experienced a concussion are evaluated by medical professionals to determine if they are fit to return to activities.

Who is required to file concussion evaluation and release?

Any individual who has experienced a concussion and wishes to return to activities must file a concussion evaluation and release form.

How to fill out concussion evaluation and release?

Individuals should consult with their medical provider to fill out the concussion evaluation and release form accurately.

What is the purpose of concussion evaluation and release?

The purpose of concussion evaluation and release is to ensure the safety and well-being of individuals who have experienced a concussion before allowing them to return to activities.

What information must be reported on concussion evaluation and release?

The concussion evaluation and release form typically requires information such as the date of the concussion, symptoms experienced, and results of medical evaluation.