confidential point-to-point â doctors report form a ... AWS
CONFIDENTIAL
POINT-TO-POINT – DOCTORS REPORT FORM A (2017 - 2018 SEASON)
Point-to-Point...............................................................................................................................................………………………………Date..................................................................................................................... PLEASE ENSURE THAT ALL FALLERS AND CLEARANCES ARE RECORDED ON THIS FORM. IF A RIDER FAILS TO REPORT TO A DOCTOR AFTER A FALL (OR REFUSES TO BE EXAMINED OR TREATED) THEIR DETAILS MUST STILL BE RECORDED AND THE RELEVANT BOXES COMPLETED. Race No.
Details of Injury Or Details of Red Entry Cleared
Name of Rider
Mechanism, Findings, Management, Final destination
* Classification of Injury: 0 = no injury
1 = minor soft tissue injury
2 = intermediate (limb #, clavicle #, minor concussion)
Classification of Injury *0/1/2/3
Rider failed to report/ refused assessment RE CMA
Red Entry Status
RMO’s
Previous RE Cleared – Now Fit to Ride
Signature
New RE (RMO) New RE (CMA)
3 = major (unconscious, # skull, spinal cord injury)
NAME and SIGNATURE (Doctor)................................................................................................ (Clerk of the Course)............................................................................................................................................................ Contact Details of Doctor (Block Capitals)................................................................................................................................................................................................................................................................................
THIS REPORT MUST BE COMPLETED AND RETURNED IN THE S.A.E PROVIDED IMMEDIATELY AFTER THE MEETING TO: BHA MEDICAL DEPARTMENT, 75 HIGH HOLBORN, LONDON, WC1V 6LS. YOU CAN ALSO FAX A COPY (BEFORE POSTING IT) TO 020 7152 0136 OR SCAN TO [email protected] The SRMO must text CMA 07788 567440 to advise of any cleared or new REs or that there was a “nil return”
CONFIDENTIAL
POINT-TO-POINT – DOCTORS REPORT FORM A
Point-to-Point...............................................................................................................................................………………………………Date..................................................................................................................... Race No.
Details of Injury Or Details of Red Entry Cleared
Name of Rider
Mechanism, Findings, Management, Final destination
* Classification of Injury: 0 = no injury
1 = minor soft tissue injury
2 = intermediate (limb #, clavicle #, minor concussion)
Classification of Injury *0/1/2/3
Rider failed to report/ refused assessment RE CMA
Red Entry Status Previous RE Cleared – Now Fit to Ride New RE (RMO) New RE (CMA)
3 = major (unconscious, # skull, spinal cord injury)
RMO’s Signature
POINT TO POINT - DOCTORS REPORT FORM B
2017/2018 SEASON
Point-to-Point ................................................................................................................................... Date
...................................................................................................................................
Venue
...................................................................................................................................
Senior Point-to-Point Doctor: NAME....................................................................... Signature.......................................................... Contact telephone number............................................................................................................... GMC Number…………………………………………………………………………………………………………………………… Names of all the other Doctors in attendance NAME
Signature
GMC Number
............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ Paramedics (MUST BE COMPLETED IN FULL) – only Paramedics who are currently registered with the HCPC as a PARAMEDIC in the UK may undertake duties as a Paramedic in racing 1. NAME............................................................................................................................................. Paramedic HCPC Reg No............................................................................................................... Signature....................................................................................................................................... 2. NAME............................................................................................................................................. Paramedic HCPC Reg No............................................................................................................... Signature....................................................................................................................................... Comments and Recommendations for the future: ............................................................................................................................................................ ............................................................................................................................................................ Continue overleaf if necessary …
THIS REPORT MUST BE COMPLETED AND RETURNED WITH REPORT FORM "A" TO THE BHA MEDICAL DEPARTMENT …......................................................................................................................................................... …......................................................................................................................................................... ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ FAO: Chief Medical Adviser British Horseracing Authority 75 High Holborn London WC1V 6LS Tel 020 7152 0111 Fax 020 7152 0136
POINT-TO-POINT – DOCTORS REPORT FORM A (2017 - 2018 SEASON)
Point-to-Point...............................................................................................................................................………………………………Date..................................................................................................................... PLEASE ENSURE THAT ALL FALLERS AND CLEARANCES ARE RECORDED ON THIS FORM. IF A RIDER FAILS TO REPORT TO A DOCTOR AFTER A FALL (OR REFUSES TO BE EXAMINED OR TREATED) THEIR DETAILS MUST STILL BE RECORDED AND THE RELEVANT BOXES COMPLETED. Race No.
Details of Injury Or Details of Red Entry Cleared
Name of Rider
Mechanism, Findings, Management, Final destination
* Classification of Injury: 0 = no injury
1 = minor soft tissue injury
2 = intermediate (limb #, clavicle #, minor concussion)
Classification of Injury *0/1/2/3
Rider failed to report/ refused assessment RE CMA
Red Entry Status
RMO’s
Previous RE Cleared – Now Fit to Ride
Signature
New RE (RMO) New RE (CMA)
3 = major (unconscious, # skull, spinal cord injury)
NAME and SIGNATURE (Doctor)................................................................................................ (Clerk of the Course)............................................................................................................................................................ Contact Details of Doctor (Block Capitals)................................................................................................................................................................................................................................................................................
THIS REPORT MUST BE COMPLETED AND RETURNED IN THE S.A.E PROVIDED IMMEDIATELY AFTER THE MEETING TO: BHA MEDICAL DEPARTMENT, 75 HIGH HOLBORN, LONDON, WC1V 6LS. YOU CAN ALSO FAX A COPY (BEFORE POSTING IT) TO 020 7152 0136 OR SCAN TO [email protected] The SRMO must text CMA 07788 567440 to advise of any cleared or new REs or that there was a “nil return”
CONFIDENTIAL
POINT-TO-POINT – DOCTORS REPORT FORM A
Point-to-Point...............................................................................................................................................………………………………Date..................................................................................................................... Race No.
Details of Injury Or Details of Red Entry Cleared
Name of Rider
Mechanism, Findings, Management, Final destination
* Classification of Injury: 0 = no injury
1 = minor soft tissue injury
2 = intermediate (limb #, clavicle #, minor concussion)
Classification of Injury *0/1/2/3
Rider failed to report/ refused assessment RE CMA
Red Entry Status Previous RE Cleared – Now Fit to Ride New RE (RMO) New RE (CMA)
3 = major (unconscious, # skull, spinal cord injury)
RMO’s Signature
POINT TO POINT - DOCTORS REPORT FORM B
2017/2018 SEASON
Point-to-Point ................................................................................................................................... Date
...................................................................................................................................
Venue
...................................................................................................................................
Senior Point-to-Point Doctor: NAME....................................................................... Signature.......................................................... Contact telephone number............................................................................................................... GMC Number…………………………………………………………………………………………………………………………… Names of all the other Doctors in attendance NAME
Signature
GMC Number
............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ Paramedics (MUST BE COMPLETED IN FULL) – only Paramedics who are currently registered with the HCPC as a PARAMEDIC in the UK may undertake duties as a Paramedic in racing 1. NAME............................................................................................................................................. Paramedic HCPC Reg No............................................................................................................... Signature....................................................................................................................................... 2. NAME............................................................................................................................................. Paramedic HCPC Reg No............................................................................................................... Signature....................................................................................................................................... Comments and Recommendations for the future: ............................................................................................................................................................ ............................................................................................................................................................ Continue overleaf if necessary …
THIS REPORT MUST BE COMPLETED AND RETURNED WITH REPORT FORM "A" TO THE BHA MEDICAL DEPARTMENT …......................................................................................................................................................... …......................................................................................................................................................... ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ FAO: Chief Medical Adviser British Horseracing Authority 75 High Holborn London WC1V 6LS Tel 020 7152 0111 Fax 020 7152 0136
