BIST Measure - Concussion Symptom Scale
Client: [Client's full name] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
Date: [Date of assessment] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
Physical Symptoms
- Headaches: [Headache severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Headache characteristics, frequency, and resolution] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Neck Pain: [Neck pain severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Neck pain characteristics, frequency, and resolution] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Light Sensitivity: [Light sensitivity severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Light sensitivity triggers and specific bothersome situations] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Sound Sensitivity: [Sound sensitivity severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Sound sensitivity triggers and specific bothersome sounds] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Dizziness/Balance Problems: [Dizziness or balance problem severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Nature, frequency, and severity of dizziness/balance problems, including any pre-existing conditions or changes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Nausea: [Nausea presence or severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Frequency, predictability, and duration of nausea episodes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Feeling "at sea" with eyes closed: [Presence of symptom] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Scenarios, frequency, and duration of "at sea" episodes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Vision Problems: [Vision problem severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Specific vision issues such as blurry or double vision, including triggers and duration of episodes] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Feeling Clumsy: [Clumsiness severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Examples of clumsiness] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
Cognitive Symptoms
- Taking Longer to Think: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Forgetful/Poor Memory: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Memory types affected, such as short-term memory or name recall] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Getting Confused Easily: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Trouble Concentrating: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
Other Symptoms
- Mood Changes (angry/irritable): [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- "Doesn't Feel Right": [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Daytime Fatigue: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Daytime sleep habits, naps, increased breaks or rest periods] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Poor Sleep: [Severity rating] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Sleep issues such as trouble falling asleep, total sleep duration, and sleep disturbances] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- Other Symptoms: [Additional concussion-related symptoms not captured above] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
Baseline Impact of Injury Score (out of 10): [Overall impact score] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
- [Specific areas of life affected by recent injuries, such as work, hobbies, or sleep] (Only include if explicitly mentioned in transcript, context or clinical note, else omit section entirely. Write in a clear, concise format.)
(Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely.) (Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)