Illinois's Youth Sports Concussion Safety Act requires schools to set Return-to-Play and Return-to-Learn protocols that a student completes before fully returning after a concussion. On this IHSA form the student and parent consent to those protocols and to sharing the treating provider's written statement, which must be attached and say it is safe to return to play and learn.
The treating physician, advanced practice nurse, physician assistant, or athletic trainer working under a physician's supervision provides the written statement attached to the form. The student and parent sign the consent, and the school records clearance dates.
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Post-concussion Consent Form (RTP/RTL)
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The form accepts a written statement from the treating physician, advanced practice nurse, physician assistant, or an athletic trainer working under a physician's supervision. For a same-day return after removal from a contest, IHSA limits clearance to certified athletic trainers, APNs, PAs and Illinois physicians licensed in all branches.
No. The student and parent sign the consent. The provider supplies a separate written statement that the school attaches; the school-use box confirms the statement is included before the school records the return-to-learn and return-to-play clearance dates.
It should indicate that, in the provider's professional judgment, it is safe for the student to return to play and return to learn. Any return-to-play and return-to-learn recommendations from the provider can be shared with appropriate persons under the parent's consent.