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Get the free Concussion Info Form - Wichita Public Schools

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KANSAS RECOMMENDED CONCUSSION & HEAD INJURY INFORMATION RELEASE FORM 20182019 This form must be signed by all student athletes and parent/guardians before the student participates in any athletic
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How to fill out concussion info form

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Step 1: Obtain a concussion info form from a healthcare provider or download it from a trusted source.
02
Step 2: Read through the form carefully to understand the information required.
03
Step 3: Fill out your personal details such as your name, age, contact information, and date of birth.
04
Step 4: Provide a detailed description of the concussion incident, including how and when it occurred.
05
Step 5: Mention any symptoms you have experienced since the incident, such as headaches, nausea, dizziness, or memory problems.
06
Step 6: Include any information about any medical treatments or examinations you have undergone related to the concussion.
07
Step 7: If applicable, provide details of previous concussions or head injuries you have had in the past.
08
Step 8: Sign and date the form to acknowledge the accuracy of the provided information.
09
Step 9: Submit the completed form to the appropriate recipient, such as your healthcare provider or school administration.

Who needs concussion info form?

01
Anyone who has suffered a concussion or suspects they have a concussion needs to fill out a concussion info form. This includes athletes who have had a head injury during sports activities, individuals involved in accidents causing head trauma, or anyone experiencing symptoms associated with a concussion. It is important to provide accurate information to healthcare providers or relevant authorities to ensure appropriate diagnosis, treatment, and care.
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The concussion info form is a document used to report information about concussions and head injuries.
Coaches, trainers, and medical personnel are required to file the concussion info form.
The concussion info form can be filled out by providing detailed information about the concussion or head injury, including symptoms, treatment, and follow-up care.
The purpose of the concussion info form is to ensure that proper documentation and reporting of concussions and head injuries are maintained for player safety.
The concussion info form must include details about the individual involved, symptoms experienced, date of injury, treatment received, and clearance for return to play.
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