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Health Log Overview

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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
0
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Date
Day
Key Events
School Communication
Kaiser Communication
Physical Activity
Cognitive Activity
School Attendance
Screen Time
Nap
Bed time night before
Wake time
Night Time Sleep
Kaiser Return to Play Stage
Kaiser Return to Learn Stage
Total Symptoms Mild 0-1, Moderate 2-3, Severe 4+
Headache - Mild .5-1, Moderate 2-3, Severe 4-6
Pressure in Head
Neck Pain
Nausea or Vomiting
Dizziness
Blurred Vision
Balance Problems
Light Sensitivity
Noise Sensitivity
Feeling slowed down
Feeling "in a fog"
Don't feel right
Difficulty concentrating
Difficulty remembering
Fatigue or low energy
Confusion
Drowsiness
Trouble falling sleep
More emotional
Irritability
Sadness
Nervousness or anxiousness
1
Wed, Jan 15
1
Patient got concussion at _ o’clock
Called Hospital to set up appt on 1/16, 930am
None
None
Full
0
1/14/2020, 10:00 PM
1/15/2020, 7:30 AM
9 hrs 30 mins
1. No activity
1. Complete cognitive rest
29
5
3
2
1
2
0
3
3
1
1
0
2
2
0
2
0
1
0
0
0
0
1
2
Thu, Jan 16
2
Out
0
1/15/2020, 10:00 PM
1/16/2020, 9:00 AM
11 hrs
1. No activity
1 - Complete cognitive rest
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
There are no rows in this table

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