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20112012 MS HSL ELIGIBILITY BROCHURE CONCUSSION MANAGEMENT ADDENDUM Students: Your participation in high school activities is dependent on your eligibility. PROTECT that eligibility by reviewing with

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How to fill out concussion management form

01

Step 1: Obtain a concussion management form from the appropriate source (e.g. school, healthcare provider).

02

Step 2: Read the instructions and familiarize yourself with the form.

03

Step 3: Provide the necessary personal information in the designated fields, such as name, date of birth, and contact information.

04

Step 4: Answer the questions related to the concussion history, including any previous concussions and symptoms experienced.

05

Step 5: Complete the section regarding the current injury, providing details about when and how it occurred.

06

Step 6: Provide information about any medical evaluations or treatments received for the concussion.

07

Step 7: Answer additional questions regarding academic and activity restrictions due to the concussion.

08

Step 8: Review the filled-out form for accuracy and completeness.

09

Step 9: Date and sign the form, indicating consent for the information provided.

10

Step 10: Submit the completed concussion management form to the appropriate recipient.

Who needs concussion management form?

01

Athletes who participate in contact sports, such as football, soccer, rugby, hockey, etc.

02

Students involved in sports activities at school or college.

03

Individuals who have experienced a head injury, such as a fall or motor vehicle accident.

04

Military personnel who may be at risk of concussions during combat or training.

05

Individuals working in occupations that involve a higher risk of head injuries, such as construction workers or firefighters.

06

Anyone who has experienced a concussion or is suspected of having one should fill out a concussion management form.

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What is concussion management form?

Concussion management form is a document used to track and monitor the recovery of individuals who have sustained a concussion.

Who is required to file concussion management form?

Individuals who have sustained a concussion and their healthcare providers are required to file a concussion management form.

How to fill out concussion management form?

To fill out a concussion management form, individuals must provide information about their symptoms, treatment plan, and recovery progress.

What is the purpose of concussion management form?

The purpose of a concussion management form is to ensure individuals receive appropriate care and support during their recovery from a concussion.

What information must be reported on concussion management form?

Information such as symptoms, treatment plan, recovery progress, and any impact on daily activities must be reported on a concussion management form.

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