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Concussion Management Document
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Health Log Overview
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Empty log for you to use
Date: What day it is
Day: The number of days the patient has been concussed
Key Events: Record what key things occurred that day
School Communication: Record if there is any
Hospital Communication: Record if communicated with Hospital
Physical Activity: Record the physical activities engaged in that day (i.e. stationary biking)
Cognitive Activity: Record the cognitive activities engaged in that day (i.e. thinking puzzle)
School Attendance: Record how much school the patient went to that day
Screen Time: Record how much screen time the patient did that day
Nap Time: Record how much time the patient spent napping that day
Bed Time Night Before: Record what time the patient went to bed the day before
Wake Time: Record what time the patient woke up that day
Night Time Sleep: Record how much time the patient slept
Return to Play Stage: Record which stage of the
Return to Play Protocol
⁠
the patient is on
Return to Learn Stage: Record which stage of the
Return to Learn Protocol
⁠
the patient is on
Total Symptoms: Record the total score of symptoms after scoring each one from 0 to 6

⁠
Daily Entry
⁠
⁠
My Daily Condition and Activity Journal
Wed, Jan 15
1
Patient got concussion at _ o’clock
​
Called Hospital to set up appt on 1/16, 930am
None
None
0
​
1/14/2020, 10:00 PM
1/15/2020, 7:30 AM
9 hrs 30 mins
Thu, Jan 16
2
​
​
​
​
​
0
​
1/15/2020, 10:00 PM
1/16/2020, 9:00 AM
11 hrs
There are no rows in this table
⁠

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