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Boone Grove High School CONCUSSION EVALUATION AND RELEASE TO PLAY FORM FOR LICENSED HEALTH CARE PROVIDERS (SECTION ONE: Completed by School Personnel) Student Name: ___ Referral Date: ___ Sports Team:

How to fill out concussion evaluation and release

How to fill out concussion evaluation and release

1. To fill out a concussion evaluation and release form, follow these steps:
2. Start by providing your personal information, such as name, date of birth, and contact details.
3. Next, answer questions about the incident that caused the concussion, including the date, location, and description of how it happened.
4. Specify any symptoms you are experiencing, such as headaches, dizziness, memory problems, or sensitivity to light.
5. Provide information about any medical treatment you have received for the concussion, including medications taken or medical professionals consulted.
6. Detail any previous concussions you have had, including the dates and severity of each.
7. If applicable, list any current medications or medical conditions that may impact your concussion recovery.
8. Sign and date the evaluation and release form, indicating that the information provided is accurate to the best of your knowledge.
9. Submit the completed form to the relevant healthcare professional or organization.

Who needs concussion evaluation and release?

1. Concussion evaluation and release forms are typically needed by individuals who have suffered a concussion or head injury. This can include athletes who participate in contact sports, individuals involved in accidents or falls that result in head trauma, and military personnel who experience blast-related injuries. These forms help assess the severity of the concussion, track symptoms and progress, and provide necessary documentation for medical treatment and clearance to return to activity.

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What is concussion evaluation and release?

Concussion evaluation and release is a medical assessment that determines if a person has suffered a concussion and if they are cleared to return to physical activities.

Who is required to file concussion evaluation and release?

Coaches, trainers, and healthcare professionals are required to file concussion evaluation and release for athletes who have suffered a head injury.

How to fill out concussion evaluation and release?

Concussion evaluation and release forms can be filled out by providing the athlete's medical history, details of the injury, symptoms experienced, and clearance for return to play.

What is the purpose of concussion evaluation and release?

The purpose of concussion evaluation and release is to ensure the safety of athletes by properly diagnosing concussions and determining when it is safe for them to resume physical activities.

What information must be reported on concussion evaluation and release?

The concussion evaluation and release forms must include details of the injury, symptoms, medical history, treatment received, and clearance from a healthcare professional.