Concussion Resources for

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Medical Professionals

Concussion Resources for Medical Professionals—2

© BCIRPU. All rights reserved | Version 2: Updated July 2019

The Concussion Awareness Training Tool (CATT) is a series of online educational modules and resources with the goal of standardizing concussion recognition, diagnosis, treatment, and management. Good concussion management may decrease the risk of brain damage and potentially reduce long-term health issues.

Developed by Dr. Shelina Babul, Associate Director/Sports Injury Specialist with the BC Injury Research and Prevention Unit, BC Children’s Hospital, CATT is based upon the established principles of the Consensus Statement on Concussion in Sport. The 2017 Berlin Concussion in Sport Group Consensus Statement builds on the principles outlined in previous concussion statements and aims to develop better understanding of sport-related concussion.

Research and evidence on concussions is evolving and the knowledge base is continually changing. As a result, this website is updated on a regular basis to provide current information, tools, and resources to support concussion recognition, diagnosis, treatment, and management.

cattonline.com

Concussion Resources for Medical Professionals—3

Table of Contents

List of Resources for Medical Professionals A list of resources that could be useful when seeing patients with a concussion or suspected concussion.

Management Resources for Patients

CATT Return to School: A tool providing a gradual, six-stage stepwise strategy for returning to school following a concussion.

CATT Return to Sport: A tool providing a gradual, six-stage stepwise strategy for returning to sport following a concussion.

CATT Return to Activity: A tool providing a gradual, six-stage stepwise strategy for returning to activity following a concussion.

CATT Return to Work: A tool providing a gradual, six-stage stepwise strategy for returning to work following a concussion.

CATT Medical Assessment Letter: A form completed by a licenced medical professional during the initial medical assessment. This form indicates whether or not a concussion has been diagnosed, and provides outlines for return to work, school, or activity.

CATT Medical Clearance Letter: A form completed by a licensed medical professional that clears the individual to participate in specific activities.

4

6

6

7

8

9

13

10

Concussion Resources for Medical Professionals—4

Resources for Medical Professionals

British Journal of Sports Medicine – International Consensus Statement on Concussion in Sport (2017) https://bjsm.bmj.com/content/bjsports/51/11/838.full.pdf

Ontario Neurotrauma Foundation – Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition (2018) http://braininjuryguidelines.org/concussion/

Parachute – Canadian Guideline on Concussion in Sport (2017) http://www.parachutecanada.org/downloads/injurytopics/Canadian_Guideline_on_Concussion_in_Sport-Parachute.pdf

Heads Up Clinicians – Acute Concussion Evaluation (ACE) (2006)https://www.cdc.gov/headsup/pdfs/providers/ace_v2-a.pdf

British Journal of Sports Medicine – The Sport Concussion Assessment Tool 5th Edition (SCAT5) (2017) http://bjsm.bmj.com/content/bjsports/51/11/851.full.pdf

British Journal of Sports Medicine – The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) (2017) http://bjsm.bmj.com/content/bjsports/51/11/862.full.pdf

CATT – SCAT5 and Child SCAT5 Onlinehttps://cattonline.com/scat/

Rivermead Post-Concussion Questionnaire (1995) https://drive.google.com/viewerng/viewer?url=http://www.tbi-impact.org/cde/mod_templates/12_F_06_Rivermead.pdf

PECARN Pediatric Head CT Rule (younger than 2 years) https://drive.google.com/file/d/0B96hLlM4rbvuMzFVbndLa1hWeTQ/view

PECARN Pediatric Head CT Rule (2 years or older) https://drive.google.com/file/d/0B96hLlM4rbvueVM0OGZSbjJiMHM/view

Canadian Head CT Rule (2001)https://www.mdcalc.com/canadian-ct-head-injury-trauma-rule

Canadian C-Spine Rule (2001) https://www.mdcalc.com/canadian-c-spine-rule

Concussions Ontario – Referral Indicators (2017) http://concussionsontario.org/standards/tools-resources/referral-indicators/

Canadian Concussion Collaborative – 4 Characteristics of a Good Concussion Clinic http://casem-acmse.org/wp-content/uploads/2018/06/CCES-PUB-CCC-4Qs-E-FINAL.pdf

Concussion Resources for Medical Professionals—5

Resources for Medical Professionals

Staying Up-to-Date About Concussions

International Consensus Statement on Concussion in Sport http://bjsm.bmj.com/content/bjsports/51/11/838.full.pdf

Concussion Awareness Training Tool https://cattonline.com/

Ontario Neurotrauma Foundation http://onf.org/

Parachute http://www.parachutecanada.org/injury-topics/item/concussion

Canadian Concussion Collaborative https://casem-acmse.org/resources/canadian-concussion-collaborative/

Centers for Disease Control and Prevention https://www.cdc.gov/headsup/index.html

Concussion Resources for Medical Professionals—6

Physical & cognitive

rest• Basic board gam

es, crafts, talk on phone

• Activities that do not increase heart rate or break a sw

eatLim

it/Avoid:• Com

puter, TV, texting, video gam

es, readingN

o:• School w

ork• Sports• W

ork• D

riving until cleared by a health care professional

STAG

E 2:STA

GE 3:

Part-time school

Increase school time w

ith m

oderate accomm

odations.Prior activities plus:• Increase tim

e at school• D

ecrease accom

modations

• Hom

ework – up to 30

min./day

• Classroom testing w

ith adaptations

No:

• P.E., physical activity at lunch/recess, sports, standardized testing

Comm

unicate with school

on student’s progression.

Full-time school

Full days at school, minim

al accom

modations.

Prior activities plus:• Start to elim

inate accom

modations

• Increase homew

ork to 60 m

in./day• Lim

it routine testing to one test per day w

ith adaptations

No:

• P.E., physical activity at lunch/recess, sports, standardized testing

Note: A

student is tolerating an activity if symptom

s are not exacerbated.

RestG

radually add cognitive activity including school w

ork at home

Increase school w

ork, introduce hom

ework,

decrease learning accom

modations

Work up to full

days at school, m

inimal learning

accomm

odations

When sym

ptoms start to

improve O

R after resting for 2 days m

ax, BEG

IN STA

GE 2

This tool is a guideline for managing a student’s return to school follow

ing a concussion and does not replace m

edical advice. Timelines and activities m

ay vary by direction of a health care professional.

Start with light

cognitive activity:G

radually increase cognitive activity up to 30 m

in. Take frequent breaks.Prior activities plus:• Reading, TV, draw

ing• Lim

ited peer contact and social netw

orkingContact school to create Return to School plan.

When light cognitive

activity is tolerated:

Introduce school work.

Prior activities plus:• School w

ork as per Return to School plan

Comm

unicate with school

on student’s progression.

STAG

E 1:

No:

• School attendance• Sports• W

ork

Tolerates 30 min. of

cognitive activity, introduce school w

ork at hom

e

Tolerates 60 min. of

school work in tw

o 30 m

in. intervals, BEG

IN STA

GE 3

Back to school part-tim

ePart-tim

e school w

ith maxim

um

accomm

odations.Prior activities plus:• School w

ork at school as per Return to School plan

No:

• P.E., physical activity at lunch/recess, hom

ework,

testing, sports, assem

blies, field tripsCom

municate w

ith school on student’s progression.

STAG

E 4:STA

GE 5:

AT HO

ME

AT SCHO

OL

STAG

E 6:Full-tim

e schoolFull days at school, no learning accom

modations.

• Attend all classes

• All hom

ework

• Full extracurricular involvem

ent• A

ll testingN

o:• full participation in P.E. or

sports until Return to Sport protocol com

pleted and w

ritten medical clearance

provided

Full academic load

Tolerates 120 min. of

cognitive activity in 30-45 m

in. intervals, BEGIN

STA

GE 4

Tolerates 240 min. of

cognitive activity in 45-60 m

in. intervals, BEGIN

STA

GE 5

Tolerates school full-tim

e with no learning

accomm

odations BEG

IN STA

GE 6

Return to School protocol com

pleted; focus on RETU

RN TO

SPORT

Adapted from the Return to Learn protocol by G

.F. Strong School Program (Vancouver School Board), Adolescent

and Young Adult Program, G

.F. Strong Rehabilitation Centre.

School work only

at school

Return to School

ww

w.cattonline.com

© BCIRPU

. All rights reserved | Version 11: U

pdated Decem

ber 2017

BOTH

TO

OLS

CA

N B

E U

SED

IN P

ARA

LLEL

; HO

WEV

ER, R

ETU

RN T

O S

CHO

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ULD

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COM

PLET

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EFO

RE R

ETU

RN T

O S

PORT

IS C

OM

PLET

ED

If ne

w o

r wor

seni

ng s

ympt

oms

are

expe

rienc

ed a

t any

sta

ge, g

o ba

ck to

the

prev

ious

sta

ge fo

r at l

east

24

hour

s. Yo

u m

any

need

to m

ove

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tage

mor

e th

an o

nce

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g th

e re

cove

ry p

roce

ss.

Med

ical

cle

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ce re

quire

d be

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ing

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tage

5

Ligh

t ae

robi

c ex

erci

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alki

ng, s

wim

min

g,

stat

iona

ry c

yclin

g.

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resi

stan

ce tr

aini

ng.

The

pace

of t

hese

ac

tiviti

es s

houl

d be

at

the

poin

t whe

re y

ou

are

still

abl

e to

hav

e a

conv

ersa

tion.

Spor

t-sp

ecifi

c ex

erci

seSk

atin

g dr

ills

(ice

hock

ey),

runn

ing

drill

s (s

occe

r).

No

head

-impa

ct a

ctiv

ities

.

Non

-con

tact

dri

llsPr

ogre

ss to

com

plex

tr

aini

ng d

rills

(e

.g. p

assi

ng d

rills

).

May

sta

rt re

sist

ance

tr

aini

ng.

Full-

cont

act

prac

tice

Follo

win

g m

edic

al

clea

ranc

e pa

rtic

ipat

e in

no

rmal

trai

ning

act

iviti

es.

Back

in th

e ga

me

Nor

mal

gam

e pl

ay

Not

e: P

rem

atur

e re

turn

to

con

tact

spo

rts

(ful

l pr

acti

ce a

nd g

ame

play

) m

ay c

ause

a s

igni

fican

t se

tbac

k in

reco

very

.

Reco

very

Incr

ease

hea

rt ra

teA

dd m

ovem

ent

Exer

cise

, coo

rdin

atio

n,

cogn

itive

load

Rest

ore

confi

denc

e;

asse

ss fu

nctio

nal s

kills

Tim

e &

Dat

e co

mpl

eted

:

Yes:

Mov

e to

sta

ge 2

No:

Con

tinue

rest

ing

Sym

ptom

s im

prov

e or

2

days

rest

max

?

Tim

e &

Dat

e co

mpl

eted

:

Yes:

Mov

e to

sta

ge 3

No:

Ret

urn

to s

tage

1

No

new

or w

orse

ning

sy

mpt

oms

for 2

4 ho

urs?

Tim

e &

Dat

e co

mpl

eted

:

Yes:

Mov

e to

sta

ge 4

No:

Ret

urn

to s

tage

2

No

new

or w

orse

ning

sy

mpt

oms

for 2

4 ho

urs?

Tim

e &

Dat

e co

mpl

eted

:

Yes:

Mov

e to

sta

ge 5

No:

Ret

urn

to s

tage

3

Sym

ptom

-fre

e fo

r 24

hou

rs?

Tim

e &

Dat

e co

mpl

eted

:

Yes:

Mov

e to

sta

ge 6

No:

Ret

urn

to s

tage

4

Sym

ptom

-fre

e fo

r 24

hou

rs?

Retu

rn to

Spo

rt

No

spor

ting

ac

tivi

tyPh

ysic

al a

ndco

gniti

ve re

st u

ntil

sym

ptom

s st

art t

o im

prov

e O

R af

ter r

estin

g fo

r 2 d

ays

max

.

STA

GE

1:ST

AG

E 2:

STA

GE

3:ST

AG

E 4:

STA

GE

5:ST

AG

E 6:

This

tool

is a

gui

delin

e fo

r man

agin

g an

indi

vidu

al’s

retu

rn to

spo

rt fo

llow

ing

a co

ncus

sion

and

doe

s no

t rep

lace

m

edic

al a

dvic

e. T

imel

ines

and

act

iviti

es m

ay v

ary

by d

irect

ion

of a

hea

lth c

are

prof

essi

onal

.

ww

w.c

atto

nlin

e.co

m©

BCI

RPU

. All

right

s re

serv

ed |

Vers

ion

11: U

pdat

ed D

ecem

ber 2

017

Concussion Resources for Medical Professionals—7

Prepare to return to activity

•Test your readiness by tryingsom

e simple, fam

iliar tasks suchas reading, using the com

puter,or shopping for groceries.

•Keep the time on each activity

brief (e.g., less than 30 minutes)

and take regular rest breaks.

•Go for w

alks or try otherlight physical activity (e.g.,sw

imm

ing, stationary bike),w

ithout becoming short of

breath.

•Keep bed rest during the day toa m

inimum

. It is unlikely to helpyour recovery.

Increase your activity

•Gradually return to usual

activities and decrease restbreaks.

•Start with less dem

andingactivities before harder ones.

•Physical activity might include

jogging, lifting light weights,

or non-contact sport drills,gardening, dancing.

Note: You could start returning

to school or work on a part-tim

e basis (e.g., a few

hours per day).

Gradually resum

e daily activities

Resuming daily activities can be

challenging because your energy and capacity for activities m

ay be variable, but should im

prove day-to-day or w

eek-to-week.

Students and workers m

ay require accom

modations, such

as reduced hours, reduced w

orkload, extra time for

assignments, or access to a

quiet distraction-free work

environment.

Full return to activity

•Full class schedule, with no rest

breaks or accomm

odations.•Full w

ork schedule with usual

expectations for productivity•Student athletes should not

return to sport competition

until they have fully returned toschool.

Only return to contact sports

or dangerous job duties (e.g., operating heavy equipm

ent, w

orking from heights) w

hen cleared by your doctor.

RestG

et ready to returnStart your return

Continue your return

Return to Activity

Initial rest

•Stay home in a quiet and calm

environment.

•Limit your screen tim

e(com

puter, television, andsm

artphone use).

•Keep any social visits brief.

•Sleep as much as your body

needs while trying to m

aintaina regular night sleepingschedule.

Note: The goal for each stage is

to find the ‘ sweet spot’ betw

een doing too m

uch and too little.

STAG

E 1:STA

GE 2:

STAG

E 3:STA

GE 4:

STAG

E 5:

This tool is a guideline for managing an individual’s return to activity follow

ing a concussion and does not replace medical advice.

Timelines and activities m

ay vary by direction of a health care professional.

When sym

ptoms start to im

prove O

R after resting for 2 days max,

BEGIN

STAG

E 2

Tolerates simple,

familiar tasks,

BEGIN

STAG

E 3

Tolerates further increase in level of activity, BEG

IN STA

GE 4

Tolerates partial return to usual activities, BEG

IN STA

GE 5

If new or w

orsening symptom

s are experienced at any stage, go back to the previous stage for at least 24 hours. You many need to m

ove back a stage more than once during the

recovery process.

Each person will progress at his/her ow

n pace. It is best not to “push” through symptom

s. If you do too much, your sym

ptoms m

ay worsen. D

ecrease your activity level and your sym

ptoms should settle. Then continue to gradually increase your activity in sm

aller increments.

ww

w.cattonline.com

Adapted from

Noah D

. Silverberg, PhD

© BCIRPU

. All rights reserved | Version 2: U

pdated June 2019.

Concussion Resources for Medical Professionals—8

Concussion Resources for Medical Professionals—9

Retu

rn to

Wor

kTh

is to

ol is

a g

uide

line

for m

anag

ing

an in

divi

dual

’s re

turn

to w

ork

follo

win

g a

conc

ussi

on a

nd d

oes

not r

epla

ce m

edic

al a

dvic

e. T

he g

oal f

or e

ach

stag

e is

to fi

nd th

e ‘s

wee

t spo

t’ be

twee

n do

ing

too

muc

h an

d do

ing

too

little

. Tim

elin

es a

nd a

ctiv

ities

may

var

y by

dire

ctio

n of

a h

ealth

car

e pr

ofes

sion

al.

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. doi

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8. ©

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right

s re

serv

ed |

Vers

ion

1: Ju

ne 2

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Reco

gniz

ing

that

wor

kpla

ce e

nviro

nmen

ts v

ary

by in

dust

ry a

nd o

ccup

atio

n, re

turn

ing

to w

ork

may

focu

s m

ore

on a

retu

rn to

cog

nitiv

e ac

tivity

, phy

sica

l act

ivity

, or a

com

bina

tion

of b

oth.

It is

nor

mal

to e

xper

ienc

e sy

mpt

oms

durin

g re

cove

ry; y

ou d

o no

t hav

e to

wai

t to

be s

ympt

om fr

ee b

efor

e re

turn

ing

to w

ork.

How

ever

, aft

er S

tage

2, i

f new

or w

orse

ning

sym

ptom

s ap

pear

at a

ny s

tage

, go

back

to th

e pr

evio

us s

tage

for a

t lea

st 2

4 ho

urs.

You

man

y ne

ed to

mov

e ba

ck a

sta

ge m

ore

than

onc

e du

ring

the

reco

very

pro

cess

.

Init

ial p

hysi

cal a

nd

cogn

itiv

e re

st•

Rest

in a

qui

et a

nd c

alm

en

viro

nmen

t.

•Tr

y ac

tiviti

es th

at d

o no

t ag

grav

ate

sym

ptom

s (e

.g.,

liste

ning

to q

uiet

m

usic

or c

olou

ring)

.

•Sl

eep

as m

uch

as y

our

body

nee

ds w

hile

tryi

ng

to m

aint

ain

a re

gula

r ni

ght s

leep

ing

sche

dule

.

Lim

it:•

Leng

thy

soci

al v

isits

.

•Sc

reen

tim

e (s

mar

tpho

ne,

com

pute

r, te

levi

sion

) and

re

adin

g.

Avoi

d:•

Spor

ts o

r phy

sica

l ac

tiviti

es th

at in

crea

se

your

hea

rt ra

te o

r cau

se

you

to b

reak

a s

wea

t.

STA

GE

2:ST

AG

E 3:

Begi

n gr

adua

ted

retu

rn to

wor

k•

Retu

rn to

wor

k ac

cord

ing

to y

our g

radu

ated

retu

rn

to w

ork

plan

, with

the

agre

ed u

pon

num

ber

of h

ours

per

day

and

ac

com

mod

atio

ns.

•A

t wor

k, s

tart

with

less

de

man

ding

act

iviti

es

befo

re m

ore

diffi

cult

ones

.

•G

radu

ally

incr

ease

w

orki

ng h

ours

wee

k-to

-wee

k, o

r soo

ner,

as

appr

opria

te.

Regu

lar w

ork

hour

s w

ith

mod

ifica

tion

s, a

s ne

eded

• D

ecre

ase

acco

mm

odat

ions

as

ene

rgy

and

capa

city

in

crea

ses.

• Ac

com

mod

atio

ns c

an

be p

hase

d ou

t in

“tria

l” pe

riods

, to

ensu

re th

at

they

are

no

long

er n

eede

d.

•M

onito

r ene

rgy

leve

ls fo

r co

mpl

etin

g ho

useh

old

task

s an

d pa

rtic

ipat

ing

in s

ocia

l or r

ecre

atio

nal

activ

ities

aft

er th

e w

ork

day.

Rest

Gra

dual

ly in

crea

se

activ

ity

Retu

rn to

wor

k w

ith

acco

mm

odat

ions

an

d a

pers

onal

ized

Re

turn

to W

ork

plan

Adj

ust w

orkp

lace

ac

com

mod

atio

ns,

as n

eede

d

Whe

n sy

mpt

oms

star

t to

impr

ove

OR

afte

r res

ting

for 2

day

s m

ax,

BEG

IN S

TAG

E 2

Ligh

t act

ivit

y

•G

radu

ally

incr

ease

co

gniti

ve a

ctiv

ity b

y tr

ying

sim

ple,

fam

iliar

ta

sks

(e.g

., re

adin

g,

wat

chin

g TV

, usi

ng th

e co

mpu

ter o

r dra

win

g).

•G

o fo

r wal

ks o

r try

ot

her l

ight

phy

sica

l ac

tivity

(e.g

., sw

imm

ing,

st

atio

nary

bik

e, li

ght

hous

ewor

k), w

ithou

t be

com

ing

shor

t of

brea

th.

•Ta

ke fr

eque

nt re

st

perio

ds; k

eep

napp

ing

to

a m

inim

um.

•Be

gin

with

brie

f per

iods

of

act

ivity

, up

to 3

0 m

inut

es.

• St

art t

hink

ing

abou

t re

turn

ing

to w

ork:

co

mm

unic

atin

g w

ith

the

wor

kpla

ce, a

retu

rnto

wor

k pl

an, a

nd y

our

com

mut

e.

Prep

are

to re

turn

to

wor

k—at

wor

k

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Medical Assessment Letter

Signature

Stamp

Medical Office, please complete:M.D. / N.P. NameMedical License #Email / Contact #Date of event / injuryDate of assessment

To Whom It May Concern:

Any individual who sustains a blow or impact to the head, face, neck or body and demonstrates any visual signs of concussion or reports any of the symptoms of concussion is recommended to be assessed by a licensed medical professional. Accordingly, I have personally completed a medical assessment on this patient.

Name of Patient:

Results of the Medical Assessment

This patient has not been diagnosed with a concussion or other injury and can return, with full participation to work, school, or physical activities without restriction.

This patient has not been diagnosed with a concussion but the assessment led to the following diagnosis and recommendations:

This patient HAS been diagnosed with a concussion. See below for concussion management protocol.

This patient has been instructed to avoid all activities that could potentially place them at risk of another concussion or head injury, or activities with implications for the safety of others (e.g., driving, dangerous job duties, and contact sports) until a licensed physician or nurse practitioner provides a Medical Clearance Letter.

Yours Sincerely,

M.D / N.P. (Please circle appropriate designation)1

1 Depending upon physician or nurse practitioner access, the Medical Assessment Letter may be completed by a nurse with access to a licensed physician or nurse practitioner. Forms completed by other health care professionals (e.g., physiotherapists, chiropractors, and other allied health care professionals) should not be accepted. It is recommended that this document be provided to the patient without charge.

Concussion Resources for Medical Professionals—

The goal of concussion management is to allow complete recovery through a safe and gradual return to work, school and physical activities following a staged approach. Note: a patient’s progess through the return to activity stages is unique to the individual. After Stage 2, if new or worsening symptoms are experienced, the patient may need to return to the previous stage for 24 hours and consider reassessment by their physician/nurse practitioner. For more detailed information on management and resources, please refer to the Concussion Awareness Training Tool (CATT) at cattonline.com.

Concussion Management

In the first 24-48 hours the patient has been instructed to have complete physical and cognitive rest prior to initiating a return to work or activity.

Not yet completed Completed on (dd/mm/yyyy) Time period has passed

Stage 2: Prepare to return to activity at home

The patient can begin the return to activity process at home by undertaking brief familiar tasks until no new or worsening concussion symptoms are experienced.

Not yet completed Completed on (dd/mm/yyyy) Time period has passed

The patient can initiate a graduated return to work, school, and physical activities on a part-time basis, by increasing and gradually resuming usual activities (supported with accommodations, modifications, and restrictions as needed) as tolerated and only at a level that does not bring on new or worsening concussion symptoms.

Not yet completed Completed on (dd/mm/yyyy) Time period has passed

Stage 3 & 4: Prepare to return to work, school, and physical activity and gradually resume daily activities

Restrictions/Accommodations Details Timeline

Stage 1: Initial Rest

Concussion Resources for Medical Professionals—11

Restrictions/Accommodations Details Timeline

The patient can return with full participation to work, school, and physical activities.

Not yet completed Completed on (dd/mm/yyyy) Time period has passed

Stage 5 & 6: Full return to work, school, and physical activities

Signature

Stamp

Yours Sincerely,

M.D / N.P. (Please circle appropriate designation)2

2 Depending upon physician or nurse practitioner access, the Medical Assessment Letter may be completed by a nurse with access to a licensed physician or nurse practitioner. Forms completed by other health care professionals (e.g., physiotherapists, chiropractors, and other allied health care professionals) should not be accepted. It is recommended that this document be provided to the patient without charge.

Concussion Resources for Medical Professionals—12

Medical Clearance Letter

Medical Office, please complete:M.D. / N.P. NameMedical License #Email / Contact #Date of Clearance Letter

To Whom It May Concern:

Patients with a concussion should be assessed and managed by a medical professional. The goal of concussion management is to support the patient’s complete recovery from concussion by promoting a safe and gradual return to activity following a staged approach. For more detailed information and resources, please refer to the Concussion Awareness Training Tool (CATT) at cattonline.com.

As part of the strategy, this patient had previously been instructed to avoid all activities that could potentially place them at risk of another concussion or head injury until a medical clearance letter is provided (due to organizational requirements, dangerous job duties, contact sports, etc.). This patient has explained the organizational requirements and the duties/activities they participate in, and I have personally completed a medical clearance on this patient.

Name of Patient:

M.D. / N.P. / Patient please complete:Date of ConcussionDate of Concussion DiagnosisOrganization/Individual Requesting Medical Clearance

Note that the patient’s recovery is individual. After Stage 2, if new or worsening concussion symptoms are experienced the patient has been instructed to return to the previous stage of the strategy for 24 hours.

This patient can return with full participation to work, school, or physical activities without restriction.

This patient can return to work, school, or physical activities with the following restriction(s):

Restriction(s)Physical & Cognitive

Details Timeline

Concussion Resources for Medical Professionals—13

This patient can return with full participation to work, school, or physical activities without accommodation.

This patient can return to work, school, or physical activities with the following accommodation(s):

Accommodation(s)Physical & Cognitive

Details Timeline

Your understanding and support are critical components in this patient’s continuing recovery.

Signature

Stamp

Yours Sincerely,

M.D / N.P. (Please circle appropriate designation)1

1 Depending upon physician or nurse practitioner access, the Medical Clearance Letter may be completed by a nurse with access to a licensed physician or nurse practitioner. Forms completed by other health care professionals (e.g., physiotherapists, chiropractors, and other allied health care professionals) should not be accepted. It is recommended that this document be provided to the patient without charge.

Concussion Resources for Medical Professionals—5Concussion Resources for Medical Professionals—5

Concussion Resources for Medical Professionals—14

Notes