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E 6145.22(4a) PAGE 1 of 2HEALTHCARE PROVIDER RELEASE CONCUSSION RETURN TO PLAY PROTOCOL Student Name: ___ Sport: ___ School: ___Birthdate: ___Date of Injury: ___ Description: ___IMPORTANT NOTE TO
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How to fill out physician concussion school care
How to fill out physician concussion school care
01
Obtain a form for physician concussion school care from the school or medical provider.
02
Fill out all personal information including the student's name, age, and date of birth.
03
Provide details about the concussion such as when it occurred, symptoms experienced, and any treatment received.
04
Include contact information for the physician or medical provider overseeing the student's care.
05
Sign and date the form to verify the information provided.
Who needs physician concussion school care?
01
Students who have experienced a concussion and need medical care while attending school.
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What is physician concussion school care?
Physician concussion school care refers to the medical assessment and management provided by a physician for students who have suffered a concussion. It includes monitoring, treatment, and guidelines for safe return to school and activities.
Who is required to file physician concussion school care?
Typically, healthcare providers who assess and treat concussions in students are required to file physician concussion school care documentation as part of their responsibility to ensure the safety and well-being of the student.
How to fill out physician concussion school care?
To fill out physician concussion school care, a physician must provide detailed information about the patient's condition, treatment provided, recommendations for return to school, and any necessary accommodations required for recovery.
What is the purpose of physician concussion school care?
The purpose of physician concussion school care is to ensure that students who have suffered a concussion receive appropriate medical attention, support for their recovery, and a structured plan for reintegration into school activities.
What information must be reported on physician concussion school care?
The information reported typically includes the patient's medical history, details of the concussion event, treatment plan, recommendations for academic adjustments, and follow-up care instructions.
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