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Appendix B SPORTS CONCUSSION PHYSICIAN CLEARANCE FOR RETURN TO PLAY FORM Student athlete has been under my care for the treatment of a concussion sustained on. I have examined the student athlete

How to fill out sports concussion physician clearance

How to fill out sports concussion physician clearance:

1. Obtain the necessary form: Start by obtaining the sports concussion physician clearance form from the appropriate authority, which could be your school, sports organization, or team.
2. Provide personal information: Fill out the form with your personal information, including your full name, date of birth, contact information, and any relevant identification numbers.
3. Specify the concussion history: Indicate whether you have had any previous concussions or head injuries by checking the appropriate box or providing additional details if required.
4. Current symptoms and medications: Describe any current symptoms related to a possible concussion, such as headaches, dizziness, or memory problems. Additionally, list any medications you are currently taking, including over-the-counter drugs and supplements.
5. Consultation details: If you have visited a healthcare professional for a concussion evaluation, provide the details of the consultation, including the name of the physician, the date of the visit, and any recommendations or treatments received.
6. Physician's evaluation: Schedule an appointment with a qualified sports concussion physician, who will evaluate your condition and determine whether you are cleared to participate in sports. Ensure that the physician completes the necessary sections of the form, including their name, signature, and contact information.
7. Parent or guardian signature: If you are a minor, make sure to have your parent or guardian sign the form to give consent and acknowledge their understanding of the risks and potential consequences.
8. Submit the form: Once you have completed all the required sections and obtained the necessary signatures, submit the sports concussion physician clearance form to the respective authority.

Who needs sports concussion physician clearance?

1. Athletes: Student-athletes participating in organized sports, regardless of age or level, usually require sports concussion physician clearance before being allowed to compete. This helps ensure their safety and reduces the risks associated with concussions.
2. High-risk occupations: Individuals working in high-risk occupations, such as professional athletes, military personnel, or first responders, may also need sports concussion physician clearance due to the nature of their work and the increased likelihood of head injuries.
3. Recreational sports participants: While sports concussion clearance is often associated with organized sports, even individuals participating in recreational activities, such as weekend leagues or community sports, can benefit from obtaining clearance to reduce the risks of unrecognized head injuries.

Note: It is important to consult the specific regulations and guidelines of the relevant sports authority or organization to determine the exact requirements for sports concussion physician clearance in your particular context.

For pdfFiller’s FAQs

What is sports concussion physician clearance?

Sports concussion physician clearance is a form that verifies a student athlete has been evaluated and cleared by a medical professional to return to sports after suffering a concussion.

Who is required to file sports concussion physician clearance?

Student athletes who have suffered a concussion are required to file sports concussion physician clearance.

How to fill out sports concussion physician clearance?

Sports concussion physician clearance should be filled out by the treating physician or medical professional who evaluated and cleared the student athlete.

What is the purpose of sports concussion physician clearance?

The purpose of sports concussion physician clearance is to ensure that student athletes are medically cleared to safely return to sports after suffering a concussion.

What information must be reported on sports concussion physician clearance?

Sports concussion physician clearance must include the date of evaluation, physician's signature, clearance date, and any restrictions or limitations.

How can I get sports concussion physician clearance?

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