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Terrebonne Parish RecreationCONCUSSION INFORMATION for parents and athletes This sheet has information to help protect your children or teens from concussion or other serious brain injury. Use this

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How to fill out concussion information sheet for

01

Obtain a concussion information sheet from a healthcare provider or organization.

02

Fill out the patient's personal information including name, date of birth, address, and emergency contact information.

03

Provide details regarding the incident that led to the suspected concussion including the date, time, and location.

04

Document any symptoms experienced by the patient such as headache, dizziness, confusion, or memory problems.

05

Include information about any previous concussions or head injuries the patient has sustained.

06

Sign and date the form to confirm that the information provided is accurate.

Who needs concussion information sheet for?

01

Athletes participating in contact sports

02

Individuals involved in high-risk activities such as biking, skateboarding, or snowboarding

03

Military personnel

04

Anyone who has experienced a head injury or concussion

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What is concussion information sheet for?

The concussion information sheet is used to provide information about concussions and their management.

Who is required to file concussion information sheet for?

Schools, sports organizations, and healthcare providers are required to file the concussion information sheet.

How to fill out concussion information sheet for?

The concussion information sheet can be filled out by providing details about the individual's concussion history, symptoms, and treatment.

What is the purpose of concussion information sheet for?

The purpose of the concussion information sheet is to ensure that individuals receive proper care and follow-up after experiencing a concussion.

What information must be reported on concussion information sheet for?

Information such as the individual's name, contact information, concussion history, symptoms, treatment plan, and follow-up care must be reported on the concussion information sheet.

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