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CLUB INDEPENDENT (CI) CONCUSSION RETURN TO PLAY AUTHORIZATION FORM CIRM001 This form is adapted from the Acute Concussion Evaluation (ACE) care plan on the U.S. Centers for Disease Control website

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How to fill out concussion return to play

01

To fill out a concussion return to play form, follow these steps:

02

Obtain the form: You can usually find the concussion return to play form on your sports team's website or by speaking with your coach or athletic trainer.

03

Personal information: Fill out your full name, date of birth, and contact information at the top of the form.

04

Medical information: Provide details about your concussion, including the date it occurred, the symptoms you experienced, and any medical treatment you received.

05

Rest and recovery: Describe the steps you have taken to rest and recover from your concussion, such as avoiding physical activity, getting enough sleep, and following your doctor's advice.

06

Return to play plan: Outline the gradual steps you will take to return to physical activity. This may include starting with light exercise and gradually increasing intensity over time.

07

Medical clearance: Have a healthcare professional assess your progress and provide clearance for you to return to play.

08

Signatures: Sign the form and have a parent or guardian sign as well, if required.

09

Submitting the form: Return the completed form to your coach, athletic trainer, or the designated person responsible for collecting concussion return to play forms.

Who needs concussion return to play?

01

Anyone who has suffered a concussion and participates in sports or physical activities should complete a concussion return to play process.

02

This includes athletes of all ages and levels, from youth sports to professional leagues.

03

Concussion return to play protocols are designed to ensure the safety and well-being of individuals who have experienced a concussion, and to gradually reintegrate them into physical activity in a controlled manner.

04

Completing a concussion return to play process is important to reduce the risk of re-injury and to ensure proper recovery from a concussion.

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What is concussion return to play?

Concussion return to play is a protocol that outlines the steps and procedures for safely allowing an athlete to return to play after suffering a concussion.

Who is required to file concussion return to play?

Coaches, trainers, and medical professionals are typically responsible for filing concussion return to play forms.

How to fill out concussion return to play?

Concussion return to play forms are usually filled out by providing information about the athlete's symptoms, recovery process, and clearance from medical professionals.

What is the purpose of concussion return to play?

The purpose of concussion return to play is to ensure the safety and well-being of the athlete by allowing them to return to play only when it is deemed medically safe to do so.

What information must be reported on concussion return to play?

Information such as the athlete's medical history, symptoms, recovery progress, and clearance from medical professionals must be reported on concussion return to play forms.

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