Concussion Patient Information Sheet
Name: _______________________________________________: You have had a concussion and need to be watched closely for
the next several days until you have completely recovered. The following information is regarding your treatment and recovery. What is a concussion? A concussion is a brain injury that is caused by a blow to the head or body. It may occur from contact with
another player, hitting a hard surface such as the ground, floor, being hit by a piece of equipment such as a bat or ball, or a motor vehicle accident. A concussion can change the way your brain normal y works. It can range from mild to severe and presents itself differently for each athlete. A concussion can happen even if you do not lose consciousness.
What are the symptoms of a concussion?
You can’t see a concussion, but you may notice some of the symptoms right away. Other
symptoms can show up hours or days after the injury. Concussion symptoms may include: • Nausea (feeling that you might vomit) • Difficulty getting to sleep or disrupted sleep (forgetting game plays, facts, meeting times)
How do you recover from a concussion? Your brain needs time to heal. Until you completely recover from your concussion, you
wil be held from al athletic activity. Exercise or activities that involve a lot of concentration, such as studying, working on the
computer, or playing video games may cause concussion symptoms (such as headache or tiredness) to reappear or get worse. While your brain is stil healing, you are much more likely to have a repeat concussion. In rare cases, repeat concussions can cause permanent brain damage, and even death. Severe brain injury can change your whole life. You will be evaluated by our team physician initial y and possibly undergo some testing to determine how the concussion is affecting your ability to balance and process information (IMPACT test). You wil be fol owed daily by your athletic trainer to monitor your symptoms. When your symptoms are completely gone and your concussion testing results have returned to a normal level, you will perform some exertion tests under the supervision of your athletic trainer. Before returning to your sport, you must be re-evaluated by your physician
and medical y cleared (by approved physician) for return.

What to watch for? If you develop any new symptoms or increases in current symptoms, contact your athletic trainer or physician
immediately at: ______________________________________________________________________________________________

Medications: You may take the following medications as directed on the bottle:
• Acetaminophen (Tylenol): as directed by bottle as needed for headache. DO NOT take more than the recommended dose
Additional Instructions: DO NOT drive a car or motor scooter, drink alcohol, eat greasy or spicy foods, or take aspirin, Aleve, Advil or

Follow-up: You will be seen for follow-up examination by ________________________ on _______________ at ________________.
Recommendations provided to ______________________________ by ______________________________ on / / .

Source: http://rabun.k12.ga.us/view/1928.pdf

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