Get the free Physician concussion eval form website revised Oct2015

PHYSICIAN CONCUSSION EVALUATION FORM Eastern High School Athletic Training and Sports Medicine Services C. Christy, MA, ATC, CSS C. Lowery, ATC Phone: (856) 7844441 x1277 Fax: (856) 7841322 Date:

How to fill out physician concussion eval form

How to fill out a physician concussion eval form:

1. Start by carefully reading the instructions on the form. Familiarize yourself with the specific sections and fields that need to be completed.
2. Begin by providing your personal information, such as your name, date of birth, address, and contact details. This section helps in identifying the patient.
3. The next step is to fill out the medical history section. Provide details of any previous concussions or head injuries, medical conditions, medications being taken, and any relevant family medical history. This information is crucial for the physician to assess the severity and impact of the current injury.
4. Proceed to the symptoms section. Here, describe any physical, cognitive, emotional, or behavioral symptoms you are experiencing as a result of the suspected concussion. Be specific and provide as much detail as possible to help the physician in their evaluation.
5. The form may also include assessment tools or questionnaires to measure the severity and impact of the concussion. Fill these out accurately and honestly, as they aid in the diagnostic process.
6. If there were witnesses to the event that caused the concussion, provide their contact information. Their accounts can provide valuable insights into the incident.
7. Finally, sign and date the form to certify that the information provided is accurate to the best of your knowledge.

Who needs a physician concussion eval form?

1. Athletes: Athletes participating in contact sports or activities with a risk of head injuries often require a physician concussion eval form. This form helps assess the severity of a suspected concussion and determines when it is safe to return to play.
2. Accident victims: Individuals involved in accidents, such as car crashes or falls, where head injuries are a possibility may need a physician concussion eval form to evaluate their condition and guide their treatment.
3. Individuals with suspected concussions: Anyone who experiences a blow to the head resulting in symptoms such as headache, dizziness, confusion, memory problems, or changes in behavior should consider obtaining a physician concussion eval form. This form aids in accurately diagnosing and managing the concussion.
4. Patients recovering from concussions: Individuals who have previously been diagnosed with a concussion and are being treated for their symptoms may require a physician concussion eval form to track their progress over time and adjust their treatment plan accordingly.

Remember, it is always important to consult with a healthcare professional, such as a physician, when dealing with a potential concussion. They can provide proper guidance and administer appropriate evaluations for an accurate diagnosis and effective treatment.

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What is physician concussion eval form?

The physician concussion evaluation form is a document that medical professionals use to assess and diagnose concussions in patients.

Who is required to file physician concussion eval form?

Any medical professional who suspects a patient has suffered a concussion is required to fill out and file the physician concussion evaluation form.

How to fill out physician concussion eval form?

The physician concussion evaluation form should be filled out by documenting the patient's symptoms, the mechanism of injury, and the results of any neurological examinations.

What is the purpose of physician concussion eval form?

The purpose of the physician concussion evaluation form is to facilitate the assessment and diagnosis of concussions in patients, ensuring they receive appropriate medical treatment.

What information must be reported on physician concussion eval form?

The physician concussion evaluation form should include details of the patient's symptoms, the circumstances surrounding the injury, and any relevant medical history.