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Name: Age/DOB: Date of Injury: Post Concussion Symptom Scale No symptoms "0 "Moderate "3 "Severe "6 " Time after Concussion SYMPTOMS Headache Nausea Vomiting Balance.

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How to use or fill out the Post Concussion Symptom Scale - Globalconcussionsorg online

Filling out the Post Concussion Symptom Scale is an important step in monitoring recovery after a concussion. This guide provides clear, step-by-step instructions on how to complete the form online to ensure accuracy and detail in reporting symptoms.

Follow the steps to accurately complete the form.

  1. Press the ‘Get Form’ button to access the form and open it for completion.
  2. Begin by entering your name in the designated field. This ensures that the information provided is attributed to you.
  3. Fill in your age or date of birth in the corresponding section. This information helps healthcare providers understand the context of your symptoms.
  4. Record the date of your injury. This is critical for tracking your symptom timeline.
  5. Review the symptoms listed under the Post Concussion Symptom Scale. Rate each symptom on a scale from 0 (no symptoms) to 6 (severe symptoms) to reflect how you currently feel.
  6. Under each symptom, indicate the duration of symptoms in days or hours, using the provided options.
  7. Once you have completed the assessments for all symptoms, calculate your total score by adding up the values assigned to each symptom.
  8. After reviewing your completed form for accuracy, you can save any changes made, download a copy for your records, print it out, or share it with your healthcare provider as necessary.

Take the first step towards recovery by completing the Post Concussion Symptom Scale online today.

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ICD-10 code F07. 81 for Postconcussional syndrome is a medical classification as listed by WHO under the range - Mental, Behavioral and Neurodevelopmental disorders .

Diagnostic and Statistical Manual, 4th Edition (DSM- IV): The DSM-IV(9) proposed criteria for PCD in- clude: (A) history of TBI causing “significant ce- rebral concussion;” (B) cognitive impairment in attention or memory; (C) at least three of eight symptoms (fatigue, sleep disturbance, headache, dizziness, ...

Postconcussive syndrome (PCS) describes the constellation of symptoms that commonly occur after mild traumatic brain injury (TBI), and patients who suffer more than one brain injury are at increased risk. Symptoms may be physical, cognitive, behavioral, and/or emotional in nature.

DSM-5 criteria There is evidence of a traumatic brain injury - that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following: Loss of consciousness. Posttraumatic amnesia. Disorientation and confusion.

The RPQ-13 score is potentially 0–52, where higher scores reflect greater severity of post concussive symptoms. The RPQ-13 items are associated with a later cluster of symptoms, although the RPQ-3 symptoms of headaches, dizziness and nausea may also be present.

The measure consists of 22 questions that relate to post-concussive symptoms. Survey-takers are asked to rate each symptom ing to a 7-point likert scale ranging from 0-6. Higher scores indicate a higher severity of post-concussive symptoms. The greatest possible score is 132 and the lowest possible score is 0.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232