Get the free Traumatic Brain Injury Disclosure Form

This form is used to document and disclose information regarding a student’s traumatic brain injury to ensure they receive appropriate accommodations from Disability Support Services at Lesley University. It requires completion by a licensed clinician or healthcare provider, outlining the student\'s condition, severity, treatment history, and suggested accommodations.

How to fill out traumatic brain injury disclosure

How to fill out traumatic brain injury disclosure

1. Begin by gathering all relevant medical documentation about the traumatic brain injury (TBI).
2. Read the disclosure form carefully to understand the required information.
3. Fill in personal details, including name, address, and contact information.
4. Provide a clear description of the traumatic brain injury, including date of diagnosis and the nature/severity of the injury.
5. Include relevant medical history and any treatments received.
6. Indicate ongoing symptoms or challenges resulting from the TBI.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form as required.

Who needs traumatic brain injury disclosure?

1. Individuals applying for disability benefits.
2. Employees reporting work-related injuries.
3. Students seeking accommodations in educational settings.
4. Athletes involved in sports-related incidents.
5. Patients undergoing evaluation for medical treatments.

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What is traumatic brain injury disclosure?

Traumatic brain injury disclosure refers to the requirement for individuals who have sustained a traumatic brain injury (TBI) to inform relevant parties, such as employers or sports organizations, about their condition, particularly when it may affect their performance or safety.

Who is required to file traumatic brain injury disclosure?

Individuals who have experienced a traumatic brain injury, particularly athletes, coaches, and medical personnel involved in sports organizations, are generally required to file TBI disclosure.

How to fill out traumatic brain injury disclosure?

To fill out traumatic brain injury disclosure, individuals typically need to provide personal information, details about the injury, the date of occurrence, symptoms experienced, and any medical treatment undergone.

What is the purpose of traumatic brain injury disclosure?

The purpose of traumatic brain injury disclosure is to ensure that individuals are aware of the ongoing effects of their injury, to promote safety, and to provide relevant parties with information necessary to make informed decisions regarding health and safety.

What information must be reported on traumatic brain injury disclosure?

Information that must be reported includes the individual's name, date of birth, date of injury, nature of the injury, medical history related to the injury, and any ongoing symptoms.