PDF-tes Name Date of Injury Date of Concussion Diagnosis

IFSTATEORG evised 022019 CIF STATES THAT RETURN TO PLAY IE COMPETITION CANNOT BE SOONER THAN 7 DAYS AFTER EVALUATION BY A PHYSICIAN MDDO WHO HAS MADE THE DIAGNOSIS OF CONCUSSION AND ONLY AFTER CO. Date of Diagnosis/Type of Injury/Treang DoctorAccidentSeverity of CondionName/Phone RELEVANT INJURIES AND MEDICAL CONDITIONS 2010 MEDICAL RELEASE CARDUSPC Introductions/ Welcome. Background. Key . Performance . Indicator (. KPI. ): How We . Are . Measuring. Timeliness . of First Report of Injury (. FROI. ). Review of First Report of Injury Report. Monitoring Compliance. Farah . Hameed. , MD. Department of Rehabilitation and Regenerative Medicine. The Sports Medicine Center for the Developing Athlete. Columbia University. New York Presbyterian Hospital. Who Am I? . Undergraduate/Graduate Training: . Meeting. May 11, 2017. The Rinks - Anaheim Ice, Club 32. 6pm-7:30pm. AGENDA & ITEMS TO DISCUSS. Jerseys & equipment update. Clinic & practice ice requests. Concussion Update. Forms on website. Andrea Aagesen, DO. Assistant Professor. Department of Physical Medicine and Rehabilitation. Michigan . NeuroSport. Eastern Michigan University Team Physician. Sports Medicine for the Primary Care Physician. Brian P . Rieger. , PhD. Chief Psychologist & Clinical Assistant Professor. Department of Physical Medicine & Rehabilitation. SUNY . Upstate. Medical University. Director, Upstate Concussion Center. Employer (Name & Address Including Zip) Carrier/Administration Claim Number Report Purpose Code Jurisdiction Jurisdiction Claim Number Insured Report Number KY Location # Evaluation (MACE) Defense and Veterans Brain Injury Center 07/2007 DVBIC.org 800-870-9244 This form may be copied for clinical use. Page 1 of 8 Patient Name: _________________________________________ Most commercial RDBMSs now provide some XML support FOR AGENCY USE ONLYPlease Type or PrintClaim NumberINSTRUCTIONS1 Complete within 24 hours of the injury2 Sign and date the completed reportClaim Examiner / Representative3 Submit to your supervisor When was your first menstrual period When was your most recent menstrual period How much time do you usually have from the start of one period to the start of another How many periods have you had in I I ----------------------Club or High School I week in gym Height/Weight / of years gymnastics Current Injury and brief history of how it happened Is this a rein jury D Yes D Questionnaire Plea A 15 Minute Update. David W. Lawrence, MD, CCFP(SEM), Dip Sport Med, MPH (. Cand. ). Overview. Definition & Diagnosis. Signs and Symptoms. Sideline Evaluation. Management. Neuropsychological . Evaluation. Dr Niamh Lynch and Professor Ronan O’Sullivan. Bon Secours Hospital, Cork. Case 1. ‘Dear Dr Lynch, Patrick is a fourteen-year-old boy who sustained a head injury whilst playing a GAA match last weekend. He had dizziness, confusion and vomiting immediately afterwards. He was brought to the local emergency department, and was observed for several hours. He was discharged home with head injury advice. Since then he complains of an increasing headache, photophobia, and dizziness. Your urgent review would be much appreciated.’.