Concussion home instructions ________________________________________________________________________________________ |
I believe that __________________________ sustained a concussion on ________________________. To make sure he/she recovers, please follow the following important recommendations: |
1. Please remind________________________________ to report to the athletic training room tomorrow at ____________________ for a follow-up evaluation. |
2. Please review the items outlined on the enclosed Physician Referral Checklist. If any of these problems develop prior to his/her visit, please call_____________________at ___________________ or contact the local EMS. Otherwise, you can follow the instructions outlined below. |
It is OK to | There is NO need to | Do NOT |
---|---|---|
Special recommendations: __________________________________________________________________________________________________________________________________________________________________________ | ||
Recommendations provided to: __________________________________________________________ | ||
Recommendations provided by: ________________Date: ________________ Time: ________________ | ||
Please feel free to contact me if you have any questions. I can be reached at: ___________________ | ||
Signature: ___________________________________ Date: ___________________________________ | ||
• Use acetaminophen (Tylenol for headaches) | • Stay in bed | • Drink alcohol |
• Eat a light diet | • Check eyes with flashlight | • Eat or drink, spicy foods or drinks |
• Use ice pack on head neck as needed for comfort | • Wake up every hour | |
• Return to school | • Test reflexes | |
• Go to sleep | ||
• Rest no strenuous activity or sports |