Tennessee's sports concussion law (T.C.A. 68-55-501) keeps a student removed for a suspected concussion out until a licensed health care provider clears return. TSSAA's form records the evaluation, physical education and sports recommendations, and a six-day gradual return-to-play plan adapted from the CDC Acute Concussion Evaluation care plan.
The treating provider fills in the evaluation details, initials the selected recommendations and signs, checking whether they are an MD, DO, clinical neuropsychologist or PA with concussion training. The athlete and family follow the plan but have no signature section.
Download the current version from the source each time; forms change without notice.
TSSAA Concussion Return to Play Form
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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The form's provider checkboxes are Medical Doctor, Osteopathic Physician, Clinical Neuropsychologist and Physician's Assistant, each with concussion training. The treating provider prints or stamps their name, office phone and address and signs the form.
Day 1 is light activity such as walking or light cycling, Day 2 moderate activity with body and head movement, Day 3 heavy non-contact activity, Day 4 sport-specific practice, Day 5 full contact in a controlled drill and Day 6 return to competition. Day 1 is the first day cleared, not the day after injury.
Yes. The same PDF on the TSSAA physical forms page contains a Spanish version, Formulario para regresar a jugar después de una conmoción cerebral, after the English pages, mirroring the English recommendations for physical education and sports.