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Early Response Concussion Service Referral Form 4255 Laurel Street Vancouver, BC V5Z 2G9 Phone: 6047144186 Fax: 6047307904 Client must meet the following inclusion criteria: o Lives within Vancouver

How to fill out early response concussion servicereferral

How to fill out early response concussion service referral:

1. Obtain the referral form: The first step in filling out the early response concussion service referral is to obtain the required form. This form can typically be obtained from healthcare providers, sports organizations, or concussion management clinics.
2. Provide personal information: Start by entering your personal information on the referral form. This may include your full name, date of birth, address, phone number, and any relevant medical or insurance information.
3. Indicate the reason for referral: In this section, clearly state the reason for the referral, which is an early response to a suspected concussion. Provide as much detail as possible, including the date and circumstances of the suspected concussion.
4. Include any previous evaluations: If you have already undergone any evaluations or assessments related to the concussion, be sure to indicate this on the referral form. If applicable, provide the names of the healthcare professionals involved and any relevant test results or reports.
5. Specify desired services: Clearly state the type of early response concussion services you are seeking. This may include neuropsychological testing, physical therapy, cognitive rehabilitation, or any other appropriate services based on your symptoms and needs.
6. Consent and signature: Read through the consent statement on the referral form carefully. If you agree to the terms and conditions, sign and date the form to provide your consent for the early response concussion services.

Who needs early response concussion service referral:

1. Athletes: Athletes of all ages who participate in contact sports, such as football, soccer, rugby, or ice hockey, may require an early response concussion service referral. This helps ensure they receive proper evaluation and appropriate care if a suspected concussion occurs during play.
2. Individuals involved in recreational activities: Anyone participating in recreational activities that have a risk of head injury, such as cycling, skateboarding, or skiing, may require an early response concussion service referral. It is important to promptly address any head injuries to minimize potential long-term effects.
3. Individuals with prior head injuries: If you have previously experienced a head injury, even if it was not diagnosed as a concussion at the time, it is important to seek an early response concussion service referral if you suspect a new head injury. This is because repeated head injuries can have cumulative effects and increase the risk of long-term complications.
4. Individuals with symptoms of a concussion: Anyone experiencing symptoms such as headache, dizziness, confusion, memory problems, sensitivity to light or noise, or changes in mood or behavior, should consider seeking an early response concussion service referral. Prompt assessment and treatment can help manage symptoms and prevent further injury.

Remember, it is always best to consult with a healthcare professional or concussion specialist for personalized advice regarding early response concussion service referrals and appropriate care for suspected head injuries.

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What is early response concussion servicereferral?

Early response concussion servicereferral is a form used to refer individuals who have experienced a concussion for timely and appropriate care and follow-up.

Who is required to file early response concussion servicereferral?

Healthcare providers, coaches, athletic trainers, and school officials are required to file early response concussion servicereferral when a concussion is suspected.

How to fill out early response concussion servicereferral?

Early response concussion servicereferral can be filled out by providing details about the individual, the suspected concussion incident, and the recommended care and follow-up.

What is the purpose of early response concussion servicereferral?

The purpose of early response concussion servicereferral is to ensure that individuals who have experienced a concussion receive appropriate care and follow-up to aid in their recovery.

What information must be reported on early response concussion servicereferral?

Information such as the individual's name, age, date of the suspected concussion incident, symptoms experienced, and recommended care plan must be reported on early response concussion servicereferral.