Occupational form
Concussion Return-to-Sport Medical Clearance
Return-to-sport clearance after a concussion is a medical decision that the athlete has completed a return-to-sport protocol and is safe for unrestricted (or specified) play. In Ontario, Rowan's Law names physicians and nurse practitioners as the clinicians who can give that confirmation for amateur competitive sport. It is not a pre-season physical and not a physiotherapy progress note.
What you are clearing
The athlete was removed from sport. A protocol (Parachute / sport-specific / school board) staged them through rest, school, light aerobic, sport-specific, non-contact, then full contact. Your signature is that symptoms have returned to baseline at the stage the organization requires, and that you assessed them. Coaches cannot substitute.
Use the organization's current medical-clearance form. Ontario sport organizations must have a return-to-sport protocol. School boards follow PPM 158. Other provinces may not have Rowan's Law; they still expect a physician or NP letter if their protocol says so.
Same-day return is not clearance
An athlete who 'feels fine' in the tournament office has not completed a protocol. Do not back-date clearance to the hour of injury. If red flags are present, this is an emergency department problem, not a form.
Who may sign
- Ontario amateur competitive sport: physician or nurse practitioner (Rowan's Law).
- Other provinces: follow that sport's protocol; usually physician or NP.
- Physiotherapists may run stages of the protocol. They do not replace the medical clearance where the law or the protocol names a physician or NP.
How to complete the clearance
- Date of injury, sport, and whether this is a repeat concussion this season.
- Red flags at the time and now (worsening headache, vomiting, focal neuro, deteriorating consciousness) — if present, do not clear.
- Current symptoms vs the athlete's baseline. Include school function, sleep, mood — not only headache.
- Which protocol stages are done. If they have not done contact practice, do not clear for a game.
- Exam: cognition as you use it, balance, neck, neuro. Normal enough to play is not 'GCS 15 in the parking lot.'
- Clearance: unrestricted, or restricted (e.g. non-contact only) with a review date.
- Advice: another blow this season comes back to you; this form is not a season-long waiver.
Worked example (fictional)
Club soccer — day 12, Ontario
Fictional 17-year-old. Do not copy onto a real clearance form.
Injury: 16 Aug 2026, heading collision, no LOC, removed from play. SCAT done pitch-side by trainer (not reviewed as a diagnosis). First visit 17 Aug: headache, photophobia, 30 min school tolerance. No red flags. Protocol (club / Rowan's Law): stages 1–4 completed per trainer log. Symptom-free at rest 5 days, full school 3 days, non-contact practice 2 days without return of symptoms. Today 28 Aug: no headache, sleep baseline, neuro exam normal, tandem gait normal, neck non-tender. Not a first concussion (one in 2024, recovered). Clearance: medically cleared for unrestricted soccer as of today. Not a pre-participation physical for the season. If symptoms return with contact, stop and return before the next game. Physician signature. NP would also be valid in Ontario for this purpose.
Why organizations refuse the note
- Signed by a parent, coach, or a profession the protocol does not allow.
- Cleared on the day of injury.
- No date of injury or sport named.
- Using a pre-season sports medical as concussion clearance.
- Symptoms still present and the form still says unrestricted.
Draft return-to-sport clearance from the visit
In Scribeberry, open Forms, search for concussion return to sport, or upload the organization's current PDF. Generate from the encounter and your notes, then edit every field before you sign. Scribeberry does not pre-map this form. You still review and sign.
Frequently asked questions
Who can clear an athlete in Ontario?
Rowan's Law specifies physicians and nurse practitioners for medical clearance to return to amateur competitive sport. Coaches and trainers run protocols. They do not replace that medical confirmation.
Is this the same as a sports medical clearance?
No. Pre-participation clearance is a baseline screen before the season. This form is return after a concussion.
What if symptoms are gone but school is still half-days?
Return to sport usually trails return to school. If cognitive load still brings symptoms, do not clear full contact. Say what stage they are in.
Does Scribeberry send the clearance to the club?
No. Scribeberry helps you complete the PDF. The athlete or parent files it with the organization. You keep a copy in the chart.
Forms
