Get the free Concussion Evaluation and Release to Play Form

This form is designed for licensed health care providers to evaluate student athletes for concussion symptoms and provide clearance for return to sports activities. It includes sections for school personnel to document incidents and for health care providers to offer clearance details based on Indiana law.

How to fill out concussion evaluation and release

How to fill out concussion evaluation and release

1. Gather necessary information about the individual being evaluated, including their medical history and any previous concussions.
2. Administer a baseline test to measure cognitive function and balance if not already done.
3. Ask the individual about their symptoms, including headache, dizziness, confusion, and any other relevant signs.
4. Conduct a physical examination to check for any neurological deficits or balance issues.
5. Score the evaluation using a standardized concussion assessment tool, such as the SCAT or ImPACT.
6. Review and document the evaluation results, noting any required recommendations for rest and recovery.
7. Ensure that the individual understands their condition and the importance of following the recovery plan.
8. Complete and sign the concussion release form once the individual has fully recovered and is cleared to return to their activities.

Who needs concussion evaluation and release?

1. Athletes in contact sports or high-risk activities who have suffered a head injury.
2. Individuals experiencing symptoms of concussion, such as headache or confusion.
3. Students in school settings after a head injury to ensure their safety during activities.
4. Anyone who has had a previous concussion and is at risk for recurrent injuries.

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What is concussion evaluation and release?

Concussion evaluation and release is a process used to determine if an individual who has suffered a head injury can safely return to play or participate in athletic activities.

Who is required to file concussion evaluation and release?

Typically, athletes, coaches, and medical professionals are required to file concussion evaluation and release forms as part of the safety protocols for sports organizations.

How to fill out concussion evaluation and release?

To fill out a concussion evaluation and release, complete the designated form with accurate details of the athlete's injury, medical evaluation results, and clearance from a qualified healthcare provider.

What is the purpose of concussion evaluation and release?

The purpose is to ensure the safety of athletes by confirming they are fit to return to play and to minimize the risk of further injury.

What information must be reported on concussion evaluation and release?

Information such as the date of the injury, symptoms observed, evaluation results, and clearance statement from a healthcare provider must be reported.