Policy #5.11.3.1-Returning after Sports Injury Medical Report

Return to Participation in Sports following Injury                                        5.11.3.1


 

            Any athlete injured during practice or game competition who requires a visit to the hospital or doctor's office or any athlete removed from a game or practice by the coach, and advised by coach to see a doctor will need written permission from the doctor before returning to active participation.

 

            Written permission from the doctor should be documented on the Medical Report form issued by the Athletic Department. The physician must indicate specific recommendations as related to any restrictions as well as the time frame to elapse prior to return to participation.

 

            Completed Medical Report forms must be submitted by the student to the Athletic Director, Coach, and High School Principal.

Adopted:         March 4, 1986

                        March 18, 1986

 

 


 

MILLIS HIGH SCHOOL ATHLETIC DEPARTMENT

MEDICAL REPORT

 

NAME                                                                        AGE                DATE

 

DATE INJURED:                  SPORT:                      PRACTICE ___ GAME ___  

 

DESCRIPTION OF INJURY:

 

 

 

 

 

 

X-RAY FINDINGS

 

 

 

 

 

DIAGNOSIS:

 

 

 

TREATMENT:

 

 

 

 

 

            RECOMMENDATIONS                              COMMENTS

___ 1. No practice until seen by: ___________________________________________

___ 2. No practice until __________________________________________________

___ 3. Running only - no contact until ______________________________________

___ 4. Practice - but no contact until ________________________________________

___ 5. No restrictions

___ 6. Other              

 

 

 

 

___________________          ___________________          ___________________

Physician                                Coach                                      Parent

 

Please return as soon as possible, as the athlete will be restricted from ALL ACTIVITY until we receive status of injury.


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