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PAGE 1 of 2HEALTHCARE PROVIDER RELEASE CONCUSSION RETURN TO PLAY PROTOCOL Student Name: Sport: School: Birthdate: Date of Injury: Description: IMPORTANT NOTE TO HEALTHCARE PROVIDER Per AS 14.30.142,
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How to fill out return to play provider

01
Obtain the necessary return to play forms from the provider.
02
Fill out your personal information, including name, date of birth, and contact information.
03
Provide details about your injury or medical condition that required you to stop participating in sports or physical activity.
04
Specify the date of your last medical evaluation and any restrictions or recommendations provided by your healthcare provider.
05
Include any additional medical documentation or test results that may be relevant to your return to play evaluation.
06
Sign and date the form to indicate your consent and understanding of the information provided.
07
Submit the completed return to play provider form to the appropriate organization or authority.

Who needs return to play provider?

01
Athletes, both amateur and professional, who have suffered an injury or medical condition that required them to stop participating in sports or physical activity need a return to play provider. This includes individuals who want to resume their athletic career or simply want to engage in recreational sports again. Return to play providers evaluate the individual's physical readiness and provide recommendations or clearances for them to safely return to sports.
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Return to play provider is a healthcare professional who is responsible for assessing an athlete's readiness to return to sports after an injury.
Coaches, team physicians, and athletic trainers are required to file return to play provider.
Return to play provider form must be filled out with the athlete's medical history, current physical condition, and any restrictions or recommendations for return to play.
The purpose of return to play provider is to ensure the health and safety of the athlete by making sure they are physically and mentally ready to return to sports.
Return to play provider must include details of the athlete's injury, treatment plan, and clearance for return to play.
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