UNIVERSITY OF CINCINNATI ATHLETICS CONCUSSION MANAGEMENT POLICY

PURPOSE The University of Cincinnati Sports Medicine Department (UCSMD) is devoted to providing the best possible medical care to every student-athlete. In accordance to the National Collegiate Athletic Association (NCAA) Sports Medicine Manual Guideline 2I and the American Athletic Conference (AAC) Concussion Management Policy, this Concussion Policy and Procedures have been developed to assist the department with prevention, recognition, evaluation, and treatment of concussion.

STAKEHOLDERS Sports Medicine Staff Coaches SASS Student-Athletes Administration Risk Management

DEFINITION There are several consensus-based definitions for concussion. Most recently, the NCAA has adopted the definition from the Congress of Neurological Surgeons:

Concussion is a change in brain function, following a force to the head, which may be accompanied by temporary loss of consciousness, but is identified in awake individuals, with measures of neurologic and cognitive dysfunction. (Carney)

Historically, there have been several grading systems for severity of concussion; however, recent consensus has abandoned such scales in an effort to individualize diagnosis and management. Therefore, members of the UCSMD will not engage in the practice of grading severity of concussion. Concussion is considered a subset of Traumatic Brain Injury (TBI), which does have various levels of severity. Any attempt at grading severity of TBI will be done in retrospect, after symptoms have cleared, and with appropriate medical personnel (i.e. Team Physician, Independent Neurology Consultant, Neurologist, etc.). Common elements of concussions include: • May be caused by a direct blow to the head or elsewhere on the body with an ‘impulsive’ force transmitted to the head. • Typically result in a rapid onset of short-lived impairment of neurologic function that resolves spontaneously. • May result in neuropathological changes, but acute clinical symptoms largely reflect a functional disturbance rather than structural injury. • Result in a graded set of clinical symptoms that may or may not involve loss of consciousness. • Resolution of the clinical and cognitive symptoms typically follows a sequential course, but post- concussive symptoms may be prolonged. Per athletics department and American Athletic Conference policy, the medical staff has the unchallengeable authority to remove a student-athlete from and to return the student-athlete to physical (return-to- participation) and cognitive (return-to-learn) activities. No coach may serve as the primary supervisor for any medical provider, or have hiring, retention or dismissal authority over that provider.

SIGNS AND SYMPTOMS The diagnosis of concussion involves an evaluation of both subjective and objective findings. Signs and symptoms are an important component for the recognition and evaluation of concussion. Recent research has indicated that the on-field presence of at least four of these symptoms is predictive of concussion lasting longer than 10 days and may also predict duration of concussion symptoms for 3 or more weeks. All athletes, coaches, and healthcare providers should be aware of the signs and symptoms, which may indicate a concussion: • Physical: Loss of consciousness, headache, nausea, vomiting, vision problems, dizziness (on-field presence indicates 4x likelihood of symptoms lasting 3 or more weeks), balance problems, fatigue, sensitivity to light/noise, ringing in ears, numbness/tingling, dazed, stunned, vacant stares

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

• Cognitive: feeling mentally “foggy”, feeling slowed down, difficulty concentrating, difficulty remembering, forgetful of recent information and conversations, confused about recent events, answers questions slowly • Emotional: irritable, sad, more emotional, nervous • Sleep: drowsiness, sleeping more than usual, sleeping less than usual, difficulty falling asleep

ANNUAL PRE-SEASON EDUCATION In accordance with the update to NCAA guidelines for concussion, educational sessions will be provided on an annual basis, and prior to the start of each academic year, to all student-athletes, coaches, UCSMD providers, and athletics administrators.

STUDENT-ATHLETES - Annual Education: concussion overview, assumption of risk, responsibility to report for self and teammates, UC concussion management, NCAA rules - Handouts: NCAA Concussion: A Fact Sheet for Student-Athletes - Forms: Concussion Acknowledgement Form

COACHES - Annual Education: concussion overview, mandate to remove and report, UC concussion management, NCAA rules, risk management - Handouts: NCAA Concussion: A Fact Sheet for Coaches, NCAA Sports Medicine Guideline 2I - Forms: Concussion Acknowledgement Form

UCSMD PROVIDERS - Annual Education: concussion overview, review and change of UC Concussion Policy and Procedures, NCAA rules, risk management - Handouts: NCAA Concussion: A Fact Sheet for Coaches, NCAA Sports Medicine Guideline 2I, SCAT5, UC Concussion Policies and Procedures - Forms: Concussion Acknowledgement Form

DIRECTOR OF ATHLETICS AND SPORTS ADMINISTRATORS - Annual Education: concussion overview, review UC Concussion Policy and Procedures, NCAA rules, risk management - Handouts: NCAA Concussion: A Fact Sheet for Coaches, NCAA Sports Medicine Guideline 2I, UC Concussion Policies and Procedures - Forms: Concussion Acknowledgement Form

PRE-PARTICIPATION ASSESSMENT OF THE STUDENT ATHLETE Baseline testing is an integral component to concussion evaluation and diagnosis. In accordance with Guideline 2I, a combination of components has been employed as part of this process, including: Signs/Symptoms Evaluation, Brain Injury/Concussion history, Cognitive Assessment and Balance evaluation. In addition, a Neuropsychological testing battery and Vision Evaluations are utilized. Such components are integrated as part of the general Pre-Participation Examination and as otherwise determined by a Team Physician. A Team Physician determines initial participation status for all medical conditions, including concussion.

PRE-PARTICIPATION COMPONENTS ALL SPORTS • SCAT5 o Brain injury/concussion history UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

o Signs/Symptoms evaluation o Cognitive assessment o Balance evaluation • Concussion Vital Signs (CVS) o Neuropsychological battery AT-RISK SPORTS (Football, Men’s/Women’s Soccer, Women’s Lacrosse, Men’s/Women’s Basketball) • Dynavision D2 Vision Testing o Proactive Test o Reaction Test • Biomarker lab work for all collision sport athletes : Mens/Women’s Soccer, Women’s Lacrosse and Football) o Samples will analyze for the same biomarkers being reviewed in the current collaborative CARE study of NCAA and Service Academy Institutions.

CONCUSSION MANAGEMENT PLAN Recognition of concussion is the responsibility of several parties including, but not limited to: the injured student-athlete, athletic trainer(s), physician(s) and other bystanders such as other student-athletes, coaches, administrators, etc. Official diagnosis of concussion comes from a Team Physician or his/her designee, when not present. A student-athlete with ANY signs/symptoms of concussion shall be removed from participation and may not return-to-participation until cleared by a Team Physician or designee, when not present.

Medical personnel with training in the diagnosis, treatment and initial management of acute concussion must be “present” at all NCAA varsity competitions in the following contact/collision sports: basketball; football; lacrosse; soccer. To be present means to be on site at the campus or arena of the competition. Medical personnel may be from either team, or may be independently contracted for the event.

Medical personnel with training in the diagnosis, treatment and initial management of acute concussion must be “available” at all NCAA varsity practices in the following non-contact/non-collision sports: baseball; golf; swimming & diving; tennis; track & field. To be available means that, at a minimum, medical personnel can be contacted at any time during the practice via telephone, messaging, email, beeper or other immediate communication means. Further, the case can be discussed through such communication, and immediate arrangements can be made for the athlete to be evaluated

Step 1: Identify the concussed athlete

• ANY loss of consciousness and/or amnesia shall be considered signs of concussion and the athlete should be disqualified from participating for the day1. • An athlete exhibiting four (4) or more trauma-induced symptoms associated with concussion should be kept from returning to play for the remainder of the day. • An athlete who exhibits a trauma-induced, 10% reduction in SCAT5 score below baseline should be kept from returning to play for the remainder of the day

Step 2: Post-Concussion Management • Should the student-athlete display major concussive symptoms, the emergency action plan shall be activated, including transportation for further medical care. Refer to the University of Cincinnati Athletics Emergency Action Plan for detailed and site specific information regarding the activation of EMS. • Major Concussive Symptoms: • Glasgow Coma Scale <13 • Prolonged loss of consciousness

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

• Focal neurological deficit suggesting intracranial trauma • Repetitive emesis • Persistently diminished/worsening mental status or other neurological signs/symptoms • Spine injury • If athlete shows ANY signs/symptoms of head injury/concussion, the athlete has to exit play and will be evaluated on sideline and/or in locker room by a member(s) of the UCSMD immediately and before return-to-play. • The on-field evaluation should include an assessment of circulation, airway, and breathing (CAB), followed by an assessment of the cervical spine and skull for associated injury7. • If signs of a life-threatening or continually deteriorating injury are present, a member(s) of the UCSMD will begin appropriate on-field management as included in emergency action plans • On the sideline the member(s) of the UCSMD will administer components of the SCAT5 evaluation, to obtain brief history of concussion, current symptoms, and cognitive performance. • If symptoms dictate, the athlete may be moved to the locker room, other designated area, to avoid bright lights, loud noises or other distractions causing acute symptoms to worsen. • The athletic trainer and/or team physician should monitor an athlete with a concussion at periodic intervals from the time of the injury until the athlete’s condition completely clears or the athlete is referred for the further care. • Supplemental oxygen has been shown to provide some relief for head injuries and may be provided to the injured athlete.

Step 3: Take Home Instructions • Once the injured student-athlete is thoroughly evaluated and determined to have sustained a concussion by a member of the UCSMD, the Concussion Take Home Sheet shall be given to the student-athlete and a designated responsible adult, who will have direct contact with the athlete for the initial 24 hours after injury o The student-athlete shall not be alone at home for at least 24 hours after injury o The responsible adult must be someone equal or older than the age of 18 and must sign the Concussion Take Home Sheet, after being given proper instruction by a member of the UCSMD

Step 4: Serial Management • A SCAT5 test shall be administered every-other-day to evaluate changes in cognition and symptoms • Baseline tests shall be re-administered within 24-48 hours after initial diagnosis and as otherwise dictated/recommended by Team Physician and/or Independent Neurology Consultant. • Evaluation by a Team Physician shall occur within 24-72 hours after initial diagnosis and again at clearance for athletic participation, or otherwise dictated by Team Physician o Team Physician will determine referral to additional specialists (independent neurology consultant, neurologist, psychologist, etc.) • Serial Management may be superseded by recommendation and communication from Team Physician and/or referred specialist(s) • Blood samples for biomarkers will be obtained at the following post-injury time intervals* : • Within two (2) hours of injury* • 24-48 hours of injury* • When symptom free and ready to begin RTP protocol* • Seven (7) days after RTP with full clearance* • Three (3), six (6), and twelve (12) months after RTP with full clearance* UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

(*pending IRB approval)

PROLONGED CONCUSSION SYMPTOMS • If the student-athlete’s symptoms are persistent and become prolonged, or if there is a reoccurrence of symptoms during the return to play progression, a neurocognitive assessment and balance re- assessment will be performed. • If symptoms become prolonged and complicated, the student-athlete should have a follow-up consultation with the Team Physician to consider additional diagnoses including, but not limited to; post-concussion syndrome, sleep dysfunction, migraine or other headache disorders, mood disorders such as anxiety and depression, or ocular/vestibular dysfunction.

RETURN-TO-PARTICIPATION Return-to-participation is solely at the discretion of a Team Physician, in collaboration with the Concussion Management Team: TEAM • Team Physician • Athletic Trainer • Neurologist/Neurosurgeon/Neurology Consultant • Psychiatrist/Psychologist • Medical Specialist SAME-DAY RETURN • A student-athlete diagnosed with concussion shall not return to play on the day of injury • Either a Team Physician or his/her designee must evaluate a student-athlete suspected of having a concussion. If a team physician is not available, the designated individual (covering athletic trainer or hosting physician) must evaluate the injured student-athlete before the athlete is cleared for same-day return-to-participation o If traveling, the hosting physician may wish to contact one of the team physicians, prior to providing clearance • The injured student-athlete >18 years old, without cognitive impairment (perfect, or within 10% baseline, whose somatic symptoms have subsided in under 20 minutes at rest and exertion, and with a normal on-field neurological exam), may be allowed to return-to- participation on the day of injury after being cleared by the team physician, hosting physician or designee, in communication with team physician. The athlete, on-site athletic trainer, on- site team physician and team physician must be unanimous in their decision for the athlete to RTP on the same day. GENERAL GUIDELINES • Once an athlete is asymptomatic, or within 10% of symptom baseline, the return-to- participation protocol should occur in a step-wise fashion, with gradual increments in physical exertion and risk of contact o This protocol shall be enlisted unless otherwise determined by a Team Physician AND in collaboration with specialist(s) recommendations (independent neurology consultant) o Progression through several steps of protocol, may occur within same-day, so long a progression from step 1 “no activity” to step 6 “full activity” does not occur within a 24 hour period.

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

Return-to-participation Protocol3-5 1. No activity Complete physical and cognitive rest until asymptomatic 2. Light aerobic exercise Walking, swimming or stationary cycling keeping intensity <70% MPHR No resistance training 3. Sports-Specific exercise Lifting, running, agility drills, no head impact activities 4. Non-Contact training drills Progression to more complex training drills: full speed agility drills, Passing/catching drills, etc. 5. Full-Contact practice Following medical clearance by team physician, participate in normal training activities 6. Full Activity Practice/Game with no restrictions The injured athlete is allowed to continue to proceed to the next step with adequate rest, if asymptomatic at the current level. If symptoms reappear, the athlete should be given an adequate rest time, dropped back to the previous asymptomatic level and try to progress again.

RETURN-TO-LEARN RATIONALE • Return-to-learn is a parallel concept to return-to-participation and is determined by the Team Physician and/or his/her designee, in collaboration with the Concussion Management Team, Student Athlete Support Services (SASS) Director of Learning Services, and the university Disability Services Office. • According to the NCAA, “the hallmark of return-to-learn is cognitive rest immediately following concussion, just as physical rest is for return-to-participation”. Cognitive rest means avoiding potential stressors such as school work, video games, reading, team meetings/practices, loud environments/people, and watching television. • Return-to-learn follows the consensus of gradual return to cognitive activity, based on return/presence of concussion symptoms following cognitive exposure.

GUIDELINES • No classroom activity on same day as a concussion. • Initial return to cognitive activity includes 30-45 minutes of recreational or at-will reading in a controlled setting o If symptoms persist, student-athlete should remain at home/dorm. • As tolerance to reading improves and there are no additional symptomatic limitations, student-athlete may return to one (1) low-level class (class that requires little reading/note taking, mathematical work, physical exertion, etc.) o If student-athlete cannot tolerate this activity, they should discontinue and return to a resting environment. • If one low-level class is tolerated, an additional class may be added the next day. o If symptoms worsen or return, student-athlete must discontinue and start process over o If cognitive activity is tolerated, step-wise return may continue on a daily basis until a full course load is resumed. • If the student-athlete has symptoms with academic challenges that become prolonged or last > 2 weeks, they shall be re-evaluated by the team physician and members of the multi- disciplinary team, as appropriate.

ACADEMIC ACCOMODATIONS • The staff athletic trainer, will work in partnership with, the SASS Director of Learning Services to navigate return-to-learn with the student-athlete.

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

• SASS Director of Learning Services will communicate internally with the SASS Director and appropriate SASS Academic Counselor. • The multi-disciplinary team that will navigate more complex cases of prolonged return-to- learn, may include, but not limited to: o Team Physician o Athletic trainer o Licensed Psychologist/counselor o Neuropsychologist consultant o Faculty athletic representative o Academic Counselor (SASS) o Course Instructors o College Administrators o Office of disability services representatives o Coaches o Director of Learning Services (SASS) • As a student-athlete completes the return-to-learn progression, academic accommodations may be needed. Such accommodations include: o No classroom activity on same day as concussion. o Class schedule changes o Special arrangements for tests, assignments, and projects § may require assistance/application through the Office of University Disability Services and/or the ADAAA Office (coordinated through SASS). • Modification of schedule/academic changes for up to two weeks, as indicated, with help of the team’s SASS staff member o Academic Accommodations o The student-athlete will have a re-evaluation by the team physician if concussion symptoms worsen with academic challenges. o The student-athlete will have by re-evaluated by the team physician and members of the multi-disciplinary team, as appropriate, for the student-athlete with symptoms > two weeks.

REDUCING EXPOSURE TO HEAD TRAUMA MANAGEMENT PLAN • Educational sessions shall be provided to sport coaches on recommendations to minimize head trauma. The UCSMD shall ensure adherence to the education provided. The education to coaches shall involve the recommendation to eliminate unnecessary contact during practice sessions and teaching proper technique to the student-athlete(s), where appropriate, for their respective sports. • The athletic trainer(s) and sport coaches shall work together to reduce gratuitous contact during practice sessions. When appropriate, the student-athlete(s) should be educated regarding safe play and proper technique for head injury reduction.

DOCUMENTION The UCSMD will document the following information in the student-athlete’s medical chart: • Initial note: timeline of injury, estimated force (high, medium, low, unknown), diagnostic procedures, current plan, etc.

• Follow-up note(s): serial assessments, diagnostic tests (SCAT5, CVS, Dynavision), presence of signs and symptoms, etc.

• Communication to non-UCSMD staff (coaches, academics, take-home)

• Any evaluation reports from UCSMD members

COMMUNICATION UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

• The UCSMD will communicate with coaches and academic staff(s) any initiation and change in student- athlete status regarding revocation and return to physical and cognitive activities.

• The UCSMD will submit all facility emergency action plans to the conference office annually, by August 1.

• For Football, 2-way communication radios will be supplied on game-day for pertinent UCSMD staff, UC Mobile Care (EMS), and the visiting team representative. Additionally, each institution’s medical staff will meet pre-game approximately 30-60 minutes before kickoff to discuss EAP (EMS location, emergency transportation, hospital, etc.), x-ray/MRI availability. Home UCSMD staff will meet with UC Mobile Care annually and review protocols before each competition.

ADDITIONAL CONSIDERATIONS MENTAL HEALTH • Mental health issues have been reported as a long-term consequence of traumatic brain injury. Therefore, if the concussed athlete shows any psychological symptoms such as depression, mental health consultation should be recommended.

SUBSTANCE ABUSE • Substance abuse has been linked to signs and symptoms of concussion. Therefore, a concussed student-athlete may be required to submit a post-concussion drug test.

ADMINISTRATIVE • University of Cincinnati Concussion Policy and Protocol will be submitted* to the Concussion Safety Protocol Committee, annually, by May 1. • *Plans must be submitted via NCAA Program Hub

• Written certificate of compliance signed by the athletics health care administrator that accompanies the submitted plan.

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

UNIVERSITY OF CINCINNATI SPORTS MEDICINE CONCUSSION TAKE HOME SHEET

Name Sport

Date/Time of Injury: Date/Time of Medical Review

At the time of your injury, the UC Sports Medicine Staff examined you for the possibility of a concussion. Based on that examination, we are recommending additional precautions.

Therefore, if you notice ANY change in behavior, vomiting/nausea, pain, worsening headache, blurry/double vision, and excessive drowsiness/ dizziness, contact a member of the UC Sports Medicine Staff IMMEDIATELY.

If any of the symptoms progress rapidly, CALL 911, then contact a member of the UC Sports Medicine Staff.

It is OK to…. Do NOT…. - Ice the head and the neck - Drink alcohol - Eat a light diet, rich in carbohydrates - Drive while symptomatic - Sleep - Take ANY medications unless you are instructed to - Rest (strenuous activity or sports) do so by a member of the UC Sports Medicine Staff - Train or play any sport until medically cleared No need to … - Check eyes with flashlight - Wake up frequently (unless instructed) - Test reflexes - Stay in bed

If problems or questions arise or exist, please contact a member of the UC Sports Medicine Staff.

Your next follow up evaluation is….

Date/Time Location

I, the above listed student-athlete have read and understand this sheet and will contact a member of the UC Sports Medicine Staff with any changes in my condition

Signature: Student Athlete Date

I, the below signed “responsible adult” have read and understand this sheet and will contact a member of the UC Sports Medicine Staff with any changes in the above listed student-athlete’s condition

Name: Responsible Adult Phone

Signature: Responsible Adult Date

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

UNIVERSITY OF CINCINNATI SPORTS MEDICINE STUDENT-ATHLETE CONCUSSION ACKNOWLEDGEMENT FORM

I, ______, acknowledge that I have a responsibility to be an active participant in my own healthcare. As such, I have the direct responsibility to report all of my injuries and illnesses to the sports medicine staff of my institution (athletic trainer or team physician). I recognize that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries and/or disabilities experienced. I hereby affirm that I have fully disclosed in writing any prior medical conditions and will also disclose any future conditions to the sports medicine staff at my institution. I understand that the sports medicine staff at the University of Cincinnati has the unchallengeable authority for my participation in intercollegiate sports for health and safety matters.

I further understand that there is a possibility that participation in my sport may result in a head injury and/or concussion. I have been provided with education on head injuries and understand the importance of immediately reporting symptoms of a head injury/concussion to my sports medicine staff. I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion-related symptoms. I also understand that if I suspect a teammate has a concussion, I am responsible for reporting the injury to my team physician and/or athletic trainer.

By signing below, I acknowledge that my institution has provided me with specific educational materials on what a concussion is and given me an opportunity to ask questions about areas and issues that are not clear to me on this issue.

I, the below signed student-athlete have read the above and agree that the statements are accurate.

______Signature of student-athlete Date

______Name of person obtaining acknowledgement

______Signature of person obtaining acknowledgement Date

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18

UNIVERSITY OF CINCINNATI SPORTS MEDICINE COACHES/DEPARTMENT STAFF CONCUSSION ACKNOWLEDGEMENT FORM

I, ______, acknowledge that as a member of The University of Cincinnati Department of Athletics, I am responsible for supporting and adhering to the department Concussion Policy and Procedures.

I understand that student-athletes have a risk of head injury and/or concussion and the importance of reporting signs and/or symptoms of concussion that I may observe, or are reported to me, to an athletic trainer or team physician. I further understand the importance of reinforcing to athletes their responsibility to report any signs and/or symptoms of concussion.

I acknowledge that purposeful or flagrant head or neck contact is not permitted and that current rules of play are to be strictly enforced. I understand that athletes shall not return to play in a game or practice on the same day they are diagnosed with concussion. Furthermore, an athlete diagnosed with concussion must follow a gradual return-to-participation and return-to-learn protocol once cleared by the sports medicine staff.

By signing below, I acknowledge that I received a copy of the department Concussion Policy and Procedures, NCAA Concussion Fact Sheet for Coaches, NCAA Guideline 2I: Concussion or Mild Traumatic Brain Injury (mTBI) in the Athlete. I was given the opportunity to ask questions to clarify issues not clear to me and received answers to my satisfaction. I further acknowledge that removal and return to any physical (i.e. practice, individuals, walk-throughs, strength and condition) and/or cognitive (i.e. classes, tutors, study hall, meetings, film) activity are the unchallengeable decision of the sports medicine staff.

______Signature of Coach/Department Staff Member Date

______Name of person obtaining acknowledgement

______Signature of person obtaining acknowledgement Date

UNIVERSITY OF CINCINNATI SPORTS MEDICINE P.O. Box 210021 Cincinnati, Ohio 45221-0021 • 513-556-4352 • GoBEARCATS.com Updated: 4/30/18