Patient name MHN DOB Age Gender Acute Concussion Evaluation (ACE) Care Plan Page 1 of 2 Service date (month/day/year) / / Injury date (month/day/year) / / You have been diagnosed with a concussion.
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the Ace Care Plan online
The Ace Care Plan is designed to assist individuals recovering from a concussion by outlining important steps and symptom management strategies. This guide provides a clear, step-by-step approach to filling out the form accurately and effectively online.
Follow the steps to complete your Ace Care Plan online.
- Press the ‘Get Form’ button to access the Ace Care Plan form and open it for editing.
- Begin by filling in the patient's personal details, including their name, date of birth (DOB), age, and gender, in the designated fields.
- Enter the service date and injury date in the appropriate 'month/day/year' format.
- Review the symptom list and check all symptoms that are currently present. Take care to ensure this section accurately reflects the patient's condition.
- Follow the guidelines for returning to daily activities by listing strategies for recovery, including rest and limitations on physical or cognitive activities.
- For the school section, select appropriate supports and interventions that will assist the patient in managing their concussion symptoms during school hours.
- Indicate whether the patient can return to sports and detail the gradual return-to-play plan, emphasizing the importance of monitoring symptoms closely.
- Complete the referral plan section by selecting appropriate healthcare provider referrals and scheduling follow-up appointments as necessary.
- Review all information entered in the form to confirm its accuracy before proceeding.
- Once complete, save any changes made to the document. From here, you'll have the options to download, print, or share the Ace Care Plan as needed.
Complete and submit your Ace Care Plan online to ensure a smooth recovery process.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
return to activities. ACUTE CONCUSSION EVALUATION (ACE). CARE PLAN. Gerard Gioia, PhD1 &...
(ACE) Care Plan. Concussion Information Sheet for ... Have a medical evaluation at least...
health-care interventions relating to family planning, child health services, basic...
Get answers to your most pressing questions about US Legal Forms API.
What is a good score on a concussion test?
An initial score of less than 5 is associated with an 80 percent chance of a lasting vegetative state or death. An initial score of greater than 11 is associated with a 90 percent chance of complete recovery (Teasdale and Jennett, 1974).
What is an ace form?
The ACE is intended to provide an evidence-based clinical protocol to conduct an initial evaluation and diagnosis of patients (both children and adults) with known or suspected MTBI.
What are 3 treatments for a concussion?
Concussion treatment Over-the-counter pain relievers. Drinking plenty of water. Concussions can cause nausea and vomiting, which lead to dehydration. Getting enough rest. Taking a break from sports and other strenuous activities. Not driving a vehicle right away. ... Avoiding alcohol while recovering. ... Brain rest.
What is the treatment plan for a concussion?
An important part of treatment for a concussion is getting plenty of rest, both sleep at night and naps or rest breaks during the day if needed. Your doctor will probably tell you to avoid certain physical activities and sports while you recover and may suggest medicine to take if you have a headache.
What are 5 steps of concussion protocol?
After more rest and no concussion symptoms, the athlete can start at the previous step. Step 1: Back to regular activities (such as school) ... Step 2: Light aerobic activity. ... Step 3: Moderate activity. ... Step 4: Heavy, non-contact activity. ... Step 5: Practice & full contact. ... Step 6: Competition.
What are the acute concussion evaluation tools?
Sport Concussion Assessment Tool (SCAT5) Red flags. Memory assessment – Maddocks Questions. Glasgow Coma Scale (GCS) examination. Cervical spine assessment. Symptom evaluation. Cognitive screening. Neurological screening. Balance examination.
What is the plan of care for a concussion?
Physical and mental rest Relative rest, which includes limiting activities that require thinking and mental concentration, is recommended for the first two days after a concussion. However, complete rest, such as lying in a dark room and avoiding all stimuli, does not help recovery and is not recommended.
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.