pediatric concussion evaluation

[text memo="#"] year old [select value="male|female"] here following a head injury that occurred on [date name="variable_1" default="11/05/2021"]. 
Patient was injured 
[textarea memo="mechanism of injury"]
Since the injury, patient's symptoms have [select value="improved|deteriorated|stayed about the same"].  

[select value="Denies|Endorses"] loss of consciousness

Red Flag Symptoms:
[checklist value="lethargy/irritability/restlessness|floppiness|abnormal breathing|poor feeding/decrease appetite|neck pain/tenderness|double vision|weakness/tingling in arms/legs|severe/increasing headache|seizure|persistent vomiting"]

[select value="denies|endorses"] history of migraine, [select value="denies|endorses"] learning problems, [select value="denies|endorses"]behavioral disorders, [select value="denies|endorses"] history of bleeding disorder, [select value="denies|endorses"] previous neurosurgery, [select value="denies|endorses"] other injuries associated.

Concussive Symptoms: 
[checklist value="disorientation/confusion|blank stare|poor balance/trouble walking|headache|vomiting|memory problems|trouble concentrating/focusing"]

(If patient is beyond the acute stage):
[checklist value="repeat head trauma|change in mood|change in sleep pattern|symptoms worse with school|symptoms worse with activity "]