Acute concussion evaluation 2026

1. Click ‘Get Form’ to open the Acute Concussion Evaluation in the editor.
2. Begin by filling out the patient’s information, including their name, date of birth, and the date of evaluation.
3. In section A, Injury Characteristics, provide details about the injury. Indicate if there was a forcible blow to the head and describe the location of impact.
4. For each symptom listed in section B, check '0' for No or '1' for Yes based on whether they have experienced these symptoms since the injury.
5. In section C, assess risk factors for protracted recovery by checking all applicable items related to concussion history and other medical conditions.
6. Review section D for any red flags that may require immediate medical attention and ensure they are documented.
7. Complete sections E and F by selecting appropriate diagnosis codes and outlining a follow-up action plan based on symptoms observed.

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