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Physician Evaluation Form This form is to be completed by the physician and returned to the Athletic Training Office. Date: ___ I have examined ___, who was injured while participating in the following

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How to fill out baseline concussion form

01

Start by providing personal information such as name, date of birth, and contact details.

02

Answer questions related to medical history, previous concussions, and any existing symptoms.

03

Perform physical tasks to assess balance, coordination, and reaction time.

04

Complete cognitive assessments including memory, concentration, and problem-solving tasks.

05

Have a healthcare professional review and sign off on the form to ensure accuracy and completeness.

Who needs baseline concussion form?

01

Athletes participating in contact sports such as football, soccer, hockey, and basketball.

02

Individuals involved in activities with a high risk of head injuries, such as skiing, biking, or skateboarding.

03

Military personnel, especially those in combat roles or training exercises.

04

Anyone at risk of sustaining a concussion due to their occupation or lifestyle.

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What is baseline concussion form?

Baseline concussion form is a document used to record an individual's baseline cognitive function and symptoms before any suspected or actual concussion.

Who is required to file baseline concussion form?

Athletes, especially those participating in contact sports, are usually required to file a baseline concussion form.

How to fill out baseline concussion form?

Baseline concussion forms typically require individuals to answer questions about their medical history, symptoms, and cognitive function.

What is the purpose of baseline concussion form?

The purpose of baseline concussion form is to establish a baseline of an individual's cognitive function and symptoms to compare against in case of a suspected or actual concussion.

What information must be reported on baseline concussion form?

Information such as medical history, current symptoms, and cognitive function tests results must be reported on a baseline concussion form.

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