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Print Form Athlete Name: Grade: Age: Date: Concussion Evaluation Form Sport: Reporter: Patient Parent Spouse Other A. Injury Characteristics Date/Time of Injury 1. Injury Description 1a. Is there.

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Related content

Acute Concussion Evaluation - CDC
Concussion may or may not involve a loss of consciousness. (LOC). Concussion results in a...
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Conducting a Pediatric Concussion Evaluation |...
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Exam and interview. ImPACT or other cognitive tests. Imaging and any other test results.

It's recommended that individuals with a concussion have a 1-2 day period of rest followed by progressive increases in activity. This return to activity should always be monitored by a trained healthcare provider. Most providers will try to see their patients 24-72 hours after the injury to assess their functioning.

Headache. Ringing in the ears. Nausea. Vomiting. Fatigue or drowsiness. Blurry vision.

Concussion tests are used to assess brain function after a head injury. A type of concussion test, called a baseline test, is often used for athletes who play contact sports, a common cause of concussion. A baseline concussion test is used on non-injured athletes before the start of a sports season.

grade 1: headache, difficulty concentrating, and a dazed feeling for less than a minute. grade 2: grade 1 symptoms, with a longer period of feeling dazed, possibly accompanied by dizziness, confusion, amnesia, ringing in the ears, and irritability. grade 3: loss of consciousness for less than a minute.

After more serious head injuries are excluded, a diagnosis of concussion can be made. Medical professionals have long used the pupillary light reflex usually in the form of a penlight test where they shine a light into a patient's eyes to assess severe forms of brain injury.

Loss of consciousness at any time. GCS <15 on initial assessment. Focal neurological deficit. Retrograde or anterograde amnesia. Persistent headache. Vomiting or seizures post injury.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232