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Concussion Information Sheet A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with

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How to fill out concussion info sheet

01

To fill out the concussion info sheet, follow these steps:

02

Start by entering the name of the person who experienced the concussion. This could be yourself or someone else.

03

Provide the date of the concussion incident. If you're unsure of the exact date, approximate it as accurately as possible.

04

Next, document the time of the concussion. Include whether it occurred in the morning, afternoon, or evening.

05

Indicate the location where the concussion took place. This could be at home, school, work, or elsewhere.

06

Describe the circumstances or events leading up to the concussion. Include any relevant details or observations.

07

State the symptoms experienced after the concussion. It may include headache, dizziness, confusion, memory loss, etc.

08

Note down any medical treatment received or ongoing treatments for the concussion.

09

Provide information about any previous concussions, if applicable.

10

Finally, sign and date the concussion info sheet to validate the information provided.

11

Remember to be as thorough and accurate as possible when filling out the form.

Who needs concussion info sheet?

01

Anyone who has experienced a concussion should fill out the concussion info sheet. This includes individuals who have suffered a head injury and are seeking medical attention or monitoring their own symptoms. Healthcare professionals may also require patients to complete this form in order to document and evaluate the concussion.

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What is concussion info sheet?

A concussion info sheet is a document that provides guidelines and important information regarding the recognition, management, and reporting of concussions among athletes.

Who is required to file concussion info sheet?

Coaches, athletic trainers, and school officials involved in youth sports programs are typically required to file a concussion info sheet.

How to fill out concussion info sheet?

To fill out a concussion info sheet, provide necessary details such as the athlete's information, date of incident, observed symptoms, actions taken, and any medical evaluations that were performed.

What is the purpose of concussion info sheet?

The purpose of the concussion info sheet is to ensure that all parties involved are informed about the symptoms and treatment protocols for concussions, aiming to protect the health and safety of the athlete.

What information must be reported on concussion info sheet?

Information that must be reported includes the athlete's name, date of birth, details of the incident, symptoms reported, any medical assessments, and follow-up actions taken.

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