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APPENDIX A Tool to Identify a Suspected Concussions sample tool is a quick reference, to be completed by school staff, to help identify a suspected concussion and to communicate this information to
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Obtain the student health form from the school or educational institution.
02
Fill in the student's personal information such as name, address, date of birth, and emergency contact information.
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Provide details of the student's medical history, including any allergies, chronic conditions, or medications being taken.
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Include information on any vaccinations the student has received and the dates they were administered.
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Have a healthcare provider sign and verify the information provided on the form.

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Allan, the student for whom the health form is being filled out, needs this student health form.
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Student health - allan refers to the health information and records specific to the student named Allan.
The individuals responsible for filing student health - allan are typically the school or educational institution where Allan is enrolled, along with Allan himself or his legal guardian.
Student health - allan can be filled out by providing relevant health information about Allan, including medical history, current medications, allergies, and any existing conditions.
The purpose of student health - allan is to ensure that Allan's health information is readily available to school staff in case of emergencies and to support his overall well-being while at school.
The information that must be reported on student health - allan may include Allan's full name, date of birth, emergency contacts, medical conditions, allergies, current medications, and any relevant healthcare providers.
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