Head Injury Tracker (HIT) Project School Application Form
School Name
School Address
Contact Person
Title
Email
Contact Phone Number
Is Your School Public or Private
Clear selection
Does your school use ImPACT™ or another neurocognitive testing software? (If not ImPACT™, please specify which one and for how long?):
Which Staff Resources Does Your School Currently Provide?
What IT Equipment Does Your School Have?
Approximately how many student athletes are in your program:
Who will be entering concussions into the HIT at your school?
Please use the space below to share any comments or concerns.
Disclaimer
The Maine Concussion Management Initiative (MCMI) seeks to promote a shared commitment to best practices regarding concussion treatment and return to play (RTP) guidelines. MCMI information, testing, and guidelines are not intended as a standard of care and should not be interpreted as such. Information from MCMI is only a guide and is of a general nature consistent with the reasonable practice of a healthcare professional. Individual treatment will depend on the facts and circumstances specific to each individual case and remain the sole responsibility of the health care provider(s).

MCMI supports the perspective on RTP decisions and patient care responsibility set forth in what is commonly referred to as the Berlin Consensus Statement, 2016, (attached or available at http://bjsm.bmj.com/51/11/838 )
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