Pennridge Community Education Foundation ImPACT Head Injury Baseline Testing Program
If during the course of the athlete’s participation in athletic program the athlete is injured and a concussion is suspected, the athlete’s physician can request that the athlete re-take the test. Then, both the initial and post-injury test data is made available to the athlete’s physician to help evaluate and treat the injury. The test data can assist the athlete’s physician in making a determination when return-to–play is appropriate and safe for the injured athlete.
To request a copy of your child’s ImPACT baseline testing results the following documents must be completed:
Download and print our Patient Authorization for Release form
Download and print our HIPAA Notice of Privacy Practices form
Return the completed forms to the Physical Medicine & Rehab Department by:
- Faxing the completed forms to Grand View’s Physical Medicine and Rehab Department at 215-453-3222.
- Delivering the forms in person to Sellersville Outpatient Center, Physical Medicine & Rehab Department, 1st Floor
- Scanning the signed forms and emailing them to HIM@gvh.org
If this form is submitted via email there is some risk that the health information contained may be read by an unauthorized third party. If you are concerned about this risk, we advise that you do not submit your form electronically.
Receiving Your Requested Health Information
Your testing results will be available for pickup in the Physical Medicine & Rehab department after one business day of receipt of request. Results cannot be emailed due to HIPAA privacy issues.
Results may be faxed directly to your physician.
Grand View Hospital
Physical Medicine & Rehab Department
915 Lawn Avenue
Sellersville, PA 18960
Department Hours: Monday – Friday 7:30am – 4:00pm