Get the free Concussion Physician Evaluation - Skaneateles School District

SKANEATELES LAKERS Skaneateles Central School District 45 East Elizabeth Street Skaneateles, New York 13152 Physician Evaluation Date of Evaluation: Student Name: Did the athlete sustain a concussion?

How to fill out concussion physician evaluation

How to fill out a concussion physician evaluation:

1. Begin by reading through the evaluation form carefully to familiarize yourself with the sections and questions. Pay attention to any instructions or guidelines provided.
2. Fill out the personal information section, which usually includes your name, date of birth, contact information, and any relevant medical history. Provide accurate and up-to-date details to ensure proper identification and communication.
3. Move on to the symptom assessment section. Here, you may be asked to rate the severity or frequency of various symptoms associated with a concussion, such as headache, dizziness, nausea, memory problems, or sensitivity to light or noise. Use the provided scale or follow the specified instructions to indicate your current condition.
4. If there is a section for describing the circumstances surrounding the concussion, write a clear and concise account of how the injury occurred. Include details about the date, time, location, activities involved, and any other relevant information that may assist the evaluating physician in understanding the context of the injury.
5. Some concussion evaluations require you to provide information about your current functional abilities. This may involve tasks related to memory, attention, concentration, problem-solving, or physical exertion. Answer honestly and to the best of your ability, as this will help the physician assess your cognitive and physical status.
6. If there is a section for medical history, provide an overview of any pre-existing conditions, previous concussions, or relevant medical treatments. Include details about any current medications or supplements you are taking, as they can impact your recovery and treatment approach.
7. Follow any additional instructions or sections on the evaluation form provided by the physician or institution. These may include details about your sleep patterns, emotional well-being, or activities you have limited or avoided since the injury.

Who needs a concussion physician evaluation:

1. Athletes: Concussions are common among athletes, especially those participating in contact sports such as football, hockey, or soccer. Getting a concussion physician evaluation is crucial for athletes to ensure proper diagnosis, treatment, and guidance for a safe return to their sport.
2. Individuals involved in accidents: Anyone involved in an accident, such as a car crash or a fall, where a head injury could have occurred should consider seeking a concussion physician evaluation. Even seemingly minor incidents can result in a concussion, and early detection and management are vital.
3. Military personnel: Given the physical demands and potential exposure to explosive blasts, military personnel are at a higher risk of sustaining concussions. Concussion physician evaluations are essential for military personnel to receive appropriate care and to guide decisions regarding continued service or rehabilitation.
4. Individuals with a high-risk occupation: Certain occupations, such as construction workers, firefighters, or law enforcement personnel, involve a higher risk of head injuries. These individuals should seek a concussion physician evaluation if they suspect they have experienced a concussion on the job.
5. Anyone experiencing concussion symptoms: Even if you don't fall into any of the above categories, if you experience symptoms of a concussion after a head injury, seeking a concussion physician evaluation is crucial. Symptoms can vary greatly in intensity and duration, and proper evaluation by a medical professional is necessary for accurate diagnosis and appropriate treatment or management.

Remember, it is always advisable to consult with a healthcare professional to get personalized advice and guidance based on your specific situation.

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What is concussion physician evaluation?

Concussion physician evaluation is a medical assessment conducted by a qualified healthcare provider to diagnose and evaluate a concussion in an individual.

Who is required to file concussion physician evaluation?

Any individual who has suffered a concussion or head injury and is seeking medical evaluation and treatment.

How to fill out concussion physician evaluation?

Concussion physician evaluations are typically filled out by healthcare providers who specialize in concussion management. They will assess the individual's symptoms, conduct a physical examination, and may order further testing if necessary.

What is the purpose of concussion physician evaluation?

The purpose of concussion physician evaluation is to diagnose and assess the severity of a concussion, develop a treatment plan, and monitor the individual's recovery progress.

What information must be reported on concussion physician evaluation?

Concussion physician evaluations typically include information about the individual's medical history, symptoms, physical examination findings, and any diagnostic test results.