Get the free Appendix 3: Concussion Referral and Return Form - northernsport eq edu

Appendix 3: Concussion Referral and Return Form SECTION 1 STUDENT & INCIDENT DETAILS (please print clearly) Section 1 (2 pages) to be completed by designated first aid officer / team official at the

How to fill out appendix 3 concussion referral

How to fill out appendix 3 concussion referral

1. Step 1: Collect all relevant information about the patient's concussion and symptoms.
2. Step 2: Download the appendix 3 concussion referral form from the designated website.
3. Step 3: Fill out the patient's personal information, including name, date of birth, and contact details.
4. Step 4: Provide information about the referring healthcare provider, including name, address, and contact details.
5. Step 5: Document the patient's medical history, including previous concussions or head injuries.
6. Step 6: Describe the patient's current symptoms and any diagnostic tests conducted.
7. Step 7: Indicate any recommended treatments or referrals to specialists.
8. Step 8: Sign and date the form.
9. Step 9: Submit the completed appendix 3 concussion referral form to the appropriate recipient.

Who needs appendix 3 concussion referral?

1. Anyone who has experienced a concussion and requires further medical evaluation or treatment should fill out appendix 3 concussion referral.

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What is appendix 3 concussion referral?

Appendix 3 concussion referral is a mandated report that outlines the details of a concussion incident, including the circumstances surrounding the injury and the subsequent actions taken.

Who is required to file appendix 3 concussion referral?

Individuals involved in managing or overseeing sports activities, including coaches, trainers, and medical personnel, are required to file the appendix 3 concussion referral.

How to fill out appendix 3 concussion referral?

To fill out appendix 3 concussion referral, provide details about the individual affected, the nature of the concussion, treatment administered, and any follow-up actions required.

What is the purpose of appendix 3 concussion referral?

The purpose of appendix 3 concussion referral is to ensure accurate reporting and monitoring of concussion cases to promote player safety and inform appropriate response protocols.

What information must be reported on appendix 3 concussion referral?

The information must include the incident details, player identification, symptoms exhibited, actions taken post-injury, and any recommendations for care or follow-up.