Sports-related concussion: Head injury history record

Current injury
Date of injury	Description: mechanism, symptoms, management at time and after

Removal from play:	Immediate	Delayed by _____ minutes
	Walked off	Assisted off	Stretchered off
	or Continued to play for _____ (minutes)

History of head injuries
Year or date occurred	Description (include: mechanism, LOC, PTA, RGA, other major symptoms/findings)	Management, including time lost from work or sport	Ongoing effects

LOC: loss of consciousness; PTA: post-traumatic amnesia; RGA: retrograde amnesia.

Graphic 138350 Version 1.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟