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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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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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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
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
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