Concussion form pdf 2026

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The document outlines the Acute Concussion Evaluation (ACE) protocol, designed for assessing and diagnosing mild traumatic brain injuries (MTBI) such as concussions. It includes sections on injury characteristics, symptom checklists, risk factors for prolonged recovery, red flags for emergency management, diagnostic codes, and follow-up action plans. The ACE aims to provide a structured approach to evaluate patients' symptoms and history related to concussions, ensuring appropriate care and monitoring.
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  1. Click ‘Get Form’ to open the concussion form PDF in the editor.
  2. Begin by entering the patient’s name, date of birth, and date at the top of the form. This information is crucial for identification.
  3. In section A, Injury Characteristics, fill out details about the injury including date/time, age, and reporter. Answer questions regarding evidence of a forcible blow and location of impact.
  4. Proceed to section B, Symptom Check List. Indicate the presence of symptoms experienced since the injury by marking '0' for No or '1' for Yes next to each symptom.
  5. In section C, check any risk factors that apply to the patient’s history. This helps assess potential complications in recovery.
  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 for diagnosis codes and follow-up action plans as necessary.

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How can I speed up concussion recovery? Reduce screen time. Limit exposure to bright lights and loud sounds. Avoid unnecessary movement of your head and neck. Stay hydrated. Rest. Eat more protein. Eat foods rich in omega-3s. Eat foods with lots of antioxidants.
A worsening headache that does not go away. Slurred speech, weakness, numbness, or decreased coordination. Repeated vomiting or nausea, convulsions, or seizures. Unusual behavior, such as increased confusion, restlessness, or agitation.
The top 5 most effective evidence-based treatment options for concussion post-concussion syndrome: Exercise Therapy. Manual Therapy Neck Injury Rehab. Diet Nutritional Changes. Vision Therapy Vestibular Therapy. Education.

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ACE concussion form pdf Concussion Form for school Concussion form for Sports Concussion evaluation form Post Concussion Questionnaire pdf Concussion screening tool Post concussion Symptom Scale score interpretation Acute Concussion Evaluation

People also ask

How can you care for yourself at home? Rest is the best treatment for post-concussion syndrome. Do not drive if you have taken a prescription pain medicine. Rest in a quiet, dark room until your headache is gone. Put a cold, moist cloth or cold pack on the painful area for 10 to 20 minutes at a time.
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.
The SCAT5 is a standardized tool for evaluating for a suspected concussion and can be used on individuals aged 13 years and older. It supersedes the original SCAT (2005), the SCAT2 (2009), and the SCAT3 (2013). For children aged 12 and under, please use the Child SCAT5.
How can I conserve energy after a concussion? You can conserve energy by using the Four Ps principle-Prioritize, Plan, Pace, and Position.
Explaining the NFLs 5-step concussion protocol Step 1: Rest and recovery. This one is simple. Step 2: Light aerobic activities. Step 3: More aerobic exercise and strength training. Step 4: Football specific activities. Step 5: Full football activity.

Related links

AYSO Participation (Return to Play) Release Form

A signed Participation (Return to Play) Release Form is required whenever a player is removed from play for a suspected concussion.

Learn more
Concussion Form - Coaches

A concussion is a brain injury. All concussions are serious. Concussions can occur without loss of consciousness. Concussion can occur in any sport.

Learn more
Acute Concussion Evaluation (ACE) - Physician/Clinician

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.

Learn more

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