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Appendix C: Initial Health History Initial Health History DOB:Student/child name:IDENTIFYING INFORMATION Grade:Age: Sex: ADDRESS: This form is completed by: Reason for assessment: Mothers Phone: Home: Fathers
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To fill out brain injury in children, follow these steps:
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Start by gathering all relevant information about the child's injury, including medical reports, test results, and any documentation from healthcare professionals.
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Begin by clearly stating the child's personal information, such as their name, age, date of birth, and contact details.
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Provide a detailed description of the brain injury, including when and how it occurred.
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Include information about the child's symptoms, both immediate and ongoing. Be as specific as possible and mention any medical treatments received.
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Discuss the impact of the brain injury on the child's physical, cognitive, and emotional well-being.
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Document any limitations or disabilities resulting from the injury, including any changes in the child's ability to communicate, move, or engage in daily activities.
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If applicable, include information about the child's rehabilitation process, therapies, and support services utilized.
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Provide any additional relevant information that may assist in evaluating the extent of the brain injury and its effects on the child.
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Who needs brain injury in children?

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Children who have experienced brain injury may require a brain injury form to document the details and impact of their injury.
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This form can be beneficial for various individuals or entities, including:
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- Parents or legal guardians of the child who want to communicate the child's brain injury history and its effects
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- Healthcare professionals who are involved in the child's care and require a comprehensive understanding of the brain injury
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- Schools or educational institutions that need to provide appropriate accommodations and support for the child
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- Legal authorities or insurance companies involved in assessing the child's eligibility for medical benefits or legal claims related to the brain injury
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- Any other party with a legitimate need for accurate information about the child's brain injury and its consequences.
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Brain injury in children refers to any type of injury to the brain that occurs during childhood, which can range from mild concussions to more severe traumatic brain injuries.
Healthcare professionals, such as doctors, nurses, and other medical staff, are required to file reports of brain injuries in children.
To fill out a report on brain injury in children, healthcare professionals must include details such as the cause of the injury, symptoms, treatment provided, and any follow-up care.
The purpose of reporting brain injuries in children is to track trends, monitor outcomes, and improve care for pediatric patients with brain injuries.
Information that must be reported on brain injury in children includes the date of injury, location, cause, symptoms, treatment, and any complications.
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