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POST CONCUSSION ASSESSMENTName: ___ Date:___ Injury Date:___ Date of Birth:___ Reporter: Patient Parent Spouse Other___ Description of Injury:Cause: Motor Vehicle Crash Premotor Vehicle Fall Sports
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How to fill out concussion and health history

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How to fill out concussion and health history

01
Start by obtaining the necessary forms from the appropriate medical professional or organization.
02
Fill out the personal information section with your name, date of birth, contact information, and any relevant medical history.
03
In the concussion history section, provide details on any previous concussions you have experienced, including the date, symptoms, and recovery process.
04
In the health history section, list any current medical conditions, allergies, medications, and surgeries you have undergone.
05
Be sure to sign and date the form, acknowledging that the information provided is accurate and complete.

Who needs concussion and health history?

01
Athletes participating in contact sports
02
Individuals involved in high-risk activities or occupations
03
Patients seeking medical treatment or surgery
04
Students enrolling in school or sports programs
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Concussion and health history refers to the documentation and assessment of an individual's past head injuries and overall health status that could affect their risk of sustaining a concussion.
Athletes participating in sports programs, particularly at school and collegiate levels, are typically required to file concussion and health history forms.
To fill out concussion and health history, individuals must provide truthful and accurate details regarding past concussions, symptoms experienced, and any relevant health conditions on the designated form.
The purpose of concussion and health history is to identify individuals at higher risk for concussions, monitor their health status, and ensure their safety during sports activities.
Reported information typically includes previous concussions, medical conditions, medications, symptoms experienced, and contact information for healthcare providers.
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