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Professional Athlete Neurological Examination Report - tennessee

Professional Athlete Neurological Examination Report - tennessee 2026

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The document is a Professional Athlete Neurological Examination Report required by the Tennessee Athletic Commission for combatants aged 35 or older. It outlines the necessary medical examination procedures to assess an athlete's neurological fitness for licensure in combative sports, including detailed sections on medical history, cranial nerves, motor skills, cerebellar function, gait, sensation, deep tendon reflexes, and mental status. The report must be completed by a licensed neurologist or neurosurgeon and includes authorization for the use and disclosure of protected health information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the participant’s full name in the designated fields for last, first, and middle names.
In the 'HISTORY' section, indicate if there are any medical history concerns that would prevent licensing by selecting 'Yes' or 'No' and providing an explanation if necessary.
Proceed to the 'EXAMINATION' section. Fill in details for cranial nerves, motor strength, tone, and range of motion as required. Be sure to note any abnormalities in the provided spaces.
Complete the 'GAIT', 'SENSATION', and 'DEEP TENDON REFLEXES' sections by documenting observations accurately.
For the 'MENTAL STATUS EXAMINATION', follow instructions carefully to assess cognitive function and record scores accordingly.
Finally, ensure that both the examining physician and applicant sign where indicated, along with their printed names and dates.

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How do you get a neurological diagnosis?

The neurologic examination is typically divided into eight components: mental status; skull, spine and meninges; cranial nerves; motor examination; sensory examination; coordination; reflexes; and gait and station. The mental status is an extremely important part of the neurologic examination that is often overlooked.

Who performs a neurological exam?

Diagnostic Tests for Neurological Disorders CT scan. Electroencephalogram (EEG). MRI. Electrodiagnostic tests, such as electromyography (EMG) and nerve conduction velocity (NCV). Positron emission tomography (PET). Arteriogram (angiogram). Spinal tap (lumbar puncture). Evoked potentials.

How do I get a neurological exam?

A neurological exam is often done by a neurologist. A neurologist is a doctor who specializes in diagnosing and treating disorders of the nervous system. Certain other providers may also do a neurological exam. The exam is usually done in a providers office.

Who can perform a neurological assessment?

A neurologist or a specially trained physician extender, like a certified nurse practitioner or physician assistant, conducts the exam. This specialist diagnoses and treats brain, nerve and spinal cord disorders. Some neurologists specialize in areas such as movement disorders, epilepsy or pediatric neurology.

How can I get a neurological exam?

A neurological examination typically assesses movement, sensation, hearing and speech, vision, coordination, and balance. It may also test mental status, mood, and behavior. The exam is usually done in a providers office. If youve had a serious injury, the exam may be done in the emergency room or at the hospital.