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 toThere is NO need toDo 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