Get the free Concussion Information Form - Carroll County Public Schools - carrollk12

Student Name Grade Sport CARROLL COUNTY PUBLIC SCHOOLS Concussion Information Sheet What can happen if my child keeps on playing with a concussion or returns to soon? Athletes with the signs and symptoms

How to fill out concussion information form

How to fill out a concussion information form:

1. Start by reading the instructions: Carefully review the form and any accompanying guidelines or instructions before you begin filling it out. This will ensure that you provide accurate and complete information.
2. Provide personal details: Begin by filling out your personal information, including your full name, date of birth, address, and contact information. This information is crucial for identifying the individual who experienced a concussion.
3. Describe the concussion incident: Provide a detailed account of the incident that led to the concussion. Include information such as the date, location, time, and the nature of the incident. This will help healthcare professionals understand the circumstances surrounding the concussion.
4. Indicate symptoms experienced: Check off any symptoms that you or the individual with the concussion have experienced. Common symptoms may include headaches, dizziness, memory problems, and sensitivity to light or noise. Be as specific as possible to assist with accurate diagnosis and treatment.
5. Medical history: Fill out any relevant medical history, including previous concussions, other injuries, current medications, and any pre-existing conditions. This information helps healthcare professionals understand the overall health profile of the individual and determine potential risk factors.
6. Provide contact information: Include emergency contact details of a responsible person who can be reached in case of any concerns or further questions. Ensure that the provided contact person is readily available and familiar with the individual's medical history.
7. Sign and date: Sign and date the form to indicate that the information provided is accurate and complete to the best of your knowledge. Failure to do so may delay the handling of the form or the access to necessary medical treatment.

Who needs a concussion information form?

Concussion information forms are typically required for anyone who has experienced a concussion. This includes athletes involved in contact sports, individuals involved in accidents or falls, and anyone who may have experienced a blow to the head. Healthcare professionals, schools, and sports organizations often use this form to gather critical information about the event, symptoms experienced, and medical history. The collected information aids in diagnosing and managing concussions effectively while ensuring appropriate treatment and care.

For pdfFiller’s FAQs

What is concussion information form?

Concussion information form is a document that gathers details about a concussion incident that occurred.

Who is required to file concussion information form?

The individuals required to file concussion information form are typically school officials, coaches, or medical staff involved in the care of athletes.

How to fill out concussion information form?

To fill out the concussion information form, you need to provide details about the athlete, the injury, the treatment received, and any follow-up care.

What is the purpose of concussion information form?

The purpose of the concussion information form is to document and track concussion incidents, ensuring proper care and protocols are followed.

What information must be reported on concussion information form?

The information reported on the concussion information form includes details about the athlete, the injury, symptoms experienced, treatment received, and follow-up care.

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