Preparticipation history, physical exam and clearance used for Nebraska school activities.
- Completed by
- Physician, PA, APRN or chiropractor
- Issued by
- Nebraska School Activities Association (NSAA)
- Format
- Language
- English and Spanish
Nebraska NSAA Concussion Clearance Form
Under Nebraska's Concussion Awareness Act, a student removed from a practice or game for a suspected concussion cannot return to athletic activity until a licensed health care professional evaluates them and signs a written clearance. This one-page NSAA form carries that clearance below a CDC fact sheet for parents and students, and the school receives it with the parent's written permission.
Who completes it
A licensed health care professional signs, dates and prints their name to acknowledge that the student-athlete can resume athletic activities. The student and a parent or guardian then sign, and the parent adds the student's grade and school.
Submitting and payment
- How to submit it
- The family submits the signed clearance to the school; the law requires it to be accompanied by written permission to resume participation from the parent or guardian.
- Who pays
- NSAA sets no fee for the clearance and the form does not say who pays for the evaluation.
Good to know
- Nebraska law defines licensed health care professional broadly: a physician, a practitioner under direct physician supervision, a certified athletic trainer, a neuropsychologist, or another state-recognized provider trained in pediatric brain injury.
- NSAA labels this form recommended, so a school may accept a different written and signed clearance that meets the Concussion Awareness Act.
- The form contains no graduated return-to-play steps or restrictions; it is a single acknowledgment that the student-athlete can resume participation in athletic activities.
- The fact sheet portion lists symptoms students report and signs parents observe, drawn from the CDC Heads Up materials on concussion in high school sports.
Get the official form
Download the current version from the source each time; forms change without notice.
Return to Play - Concussion Clearance Form (Recommended)
NSAA Formulario De Autorización De Conmoción Cerebral
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.
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
Who can sign the NSAA concussion clearance form?
A licensed health care professional as defined in the Concussion Awareness Act: a physician, a licensed practitioner under a physician's direct supervision, a certified athletic trainer, a neuropsychologist, or another individual recognized by Nebraska to provide health care who is trained in evaluating and managing traumatic brain injuries in children.
Is the Nebraska concussion clearance form available in Spanish?
Yes. NSAA posts a Spanish version, titled Formulario De Autorización De Conmoción Cerebral, on its sports medicine page next to the English form, which is listed as Return to Play - Concussion Clearance Form (Recommended).
Does the student need parent permission as well as the clearance?
Yes. Nebraska's law requires the student to submit the professional's written and signed clearance to the school together with written permission to resume participation from a parent or guardian. The NSAA form includes parent and student signature lines below the professional's signature for that purpose.