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Kansas KSHSAA Concussion Return to Play Form

Kansas law (K.S.A. 72-7119) requires a written release from a physician (MD or DO) before a student returns to full sports participation after a concussion. KSHSAA's optional one-page form pairs that release with a six-step graduated progression supervised by the athletic trainer or school medical personnel, and requires the physician's release before steps 4 to 6.

Who completes it

A physician (MD or DO) completes the evaluation section, choosing a sports participation status and noting academic modifications, and signs. The athletic trainer or school medical personnel fill in the injury details and record the date and supervisor for each step.

Submitting and payment

How to submit it
The form stays with the school's athletic trainer or school medical personnel, who supervise the progression.
Who pays
KSHSAA sets no fee and does not say who pays for the physician visit.

Good to know

  • Nurse practitioners and physician assistants cannot sign the release: the Kansas statute and the form require an MD or DO.
  • Using the KSHSAA form is optional, but the written MD or DO release is not.
  • Steps 4 to 6 begin only after symptoms, cognitive abnormalities and other clinical findings resolve, including with exertion; academic modifications should not be needed by step 4.
  • Options include cleared after completing the progression, may start the progression but must return for clearance, not cleared, or no concussion with the cause of symptoms.

Get the official form

Download the current version from the source each time; forms change without notice.

Concussion Return to Play Form

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Can a nurse practitioner clear a Kansas athlete after a concussion?

No. K.S.A. 72-7119 requires a written release from a physician, MD or DO, before a student returns to full sports participation after a concussion. The KSHSAA form's signature line is marked MD/DO, and the KSHSAA physical form repeats the same rule.

Is the KSHSAA return-to-play form required?

The form itself is not required, but the written release from an MD or DO is. Schools can use the KSHSAA form to document both the release and the graduated progression supervised by the athletic trainer or school medical personnel.

How quickly does the Kansas progression move?

Step 1 may begin within 24 to 48 hours of injury, and each later step typically takes at least 24 hours. During steps 1 to 3, more than mild symptom worsening means stopping until the next day; symptoms during steps 4 to 6 mean returning to step 3.