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Created: July 2011 Hanover County Public Schools Concussion Medical Evaluation Form To Be Completed by Medical Personnel and returned to the Licensed Athletic Trainer or School Nurse This athlete

How to fill out concussion medical evaluation form

How to fill out a concussion medical evaluation form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand what information is required and how to properly fill out each section.
2. Begin by providing your personal information, such as your full name, date of birth, and contact details. This ensures that the form is correctly identified and linked to your medical records.
3. Fill out the sections related to the incident or injury that caused the concussion. Provide a detailed description of when and how the injury occurred, any symptoms experienced, and any medical treatment received.
4. Be thorough when documenting your symptoms. List any physical, cognitive, or emotional changes you have noticed since the injury. Include details such as the frequency, intensity, and duration of each symptom.
5. If you have sought medical attention for the concussion, provide the names and contact information of the healthcare professionals who have evaluated or treated you. Include the dates of these visits and any diagnostic tests performed.
6. Include information about any pre-existing conditions or previous concussions you may have had. This helps healthcare professionals assess the potential impact and severity of the current concussion.
7. Follow the instructions regarding any additional documentation or supporting materials required. This may include medical records, test results, or photographs related to the injury.
8. Review the completed form to ensure that all sections are filled out accurately and legibly. Double-check for any missing information or errors that may affect the evaluation process.
9. Finally, sign and date the form to indicate your consent and understanding of the provided information. Make a copy of the form for your records before submitting it to the appropriate healthcare provider.

Who needs a concussion medical evaluation form?

1. Athletes: Concussion evaluation forms are commonly required for athletes participating in contact sports or activities with a high risk of head injuries. It allows coaches, trainers, and healthcare professionals to assess the athlete's condition and make informed decisions regarding their ability to return to play safely.
2. Individuals involved in accidents: Anyone who has experienced a head injury, such as a car accident or fall, may need to fill out a concussion medical evaluation form. This helps healthcare professionals evaluate the severity of the concussion and recommend appropriate treatment.
3. Military personnel: In the military, concussion medical evaluation forms are essential for assessing traumatic brain injuries (TBIs) sustained during combat or training. These forms aid in diagnosing and treating TBIs and can play a crucial role in the long-term health and well-being of service members.
4. Students: Schools and educational institutions often require concussion evaluation forms for students involved in sports or physical activities. This ensures that the student receives proper care and that necessary precautions are taken to prevent further injury while participating in these activities.

For pdfFiller’s FAQs

What is concussion medical evaluation form?

The concussion medical evaluation form is a document used to assess and document a potential concussion in an individual.

Who is required to file concussion medical evaluation form?

Medical professionals and healthcare providers are usually required to file the concussion medical evaluation form.

How to fill out concussion medical evaluation form?

To fill out the concussion medical evaluation form, detailed information about the individual's injury, symptoms, and medical history must be provided.

What is the purpose of concussion medical evaluation form?

The purpose of the concussion medical evaluation form is to accurately diagnose and assess concussions in individuals.

What information must be reported on concussion medical evaluation form?

The concussion medical evaluation form typically requires information such as symptoms, medical history, and details of the injury.

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