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TSSAA Sudden Cardiac Arrest Return to Play Release

Tennessee's Sudden Cardiac Arrest Prevention Act keeps a student who shows signs or symptoms consistent with sudden cardiac arrest out of athletics until a medical release is given. TSSAA's one-page release, printed as Medical Release for Return to Athletic Participation, records the provider's opinion after examining the student.

Who completes it

The examining health care provider completes the entire release, choosing an outcome, adding dates and restrictions, and printing, signing and dating it. Students and parents sign a separate TSSAA sudden cardiac arrest information form, not this release.

Submitting and payment

How to submit it
The family brings the signed release to the school, which keeps it before the student returns to participation.
Who pays
TSSAA sets no fee and the form does not say who pays for the evaluation.

Good to know

  • Outcomes are: unable to return until further notice with a return appointment date, limited participation from a date, re-evaluation needed before full release, or full participation from a date.
  • A restrictions section with several lines lets the provider spell out the limits that apply during limited participation.
  • The release names no required credential; it asks only for the health care provider's printed name, signature and the dates signed.
  • TSSAA lists it under Return to Play Forms beside its Concussion Return to Play Form, with a Smart Heart Act checklist among its health forms.

Get the official form

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

TSSAA Sudden Cardiac Arrest Release Form for Return to Play

Official pagePDF

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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

When is the TSSAA sudden cardiac arrest release needed?

When a student has been removed from athletics after showing signs or symptoms consistent with sudden cardiac arrest, such as fainting or chest pain. The student cannot return until a health care provider examines them and completes this medical release for return to athletic participation.

Can the provider clear a student for limited participation only?

Yes. The provider can release the student to limited participation from a set date, list restrictions, and indicate that the student must return for re-evaluation before being released for full participation. Full participation can also be released from a specific date.

Who signs the TSSAA cardiac release?

The health care provider who examined the student prints their name, signs and dates the release. The form itself does not list required credentials, so schools apply Tennessee law and TSSAA policy on which licensed providers may clear a student.