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OCDSB 908 Documentation of Medical ExaminationOCDSB 908: Documentation of Medical Examination This form to be provided to all students with a suspected concussion, as described in OCDSB 903: Concussion Awareness Tool. It is not required after every incident. _________________________ (student name) sustained a suspected concussion on ___________________ (date). As a result, the OCDSB recommends that the student be seen by a medical doctor or nurse practitioner. Prior to returning to school and/or physical activity, the parent/guardian must inform the school principal of the results of the medical examination by completing the following: Results of Medical Examination My child has been examined and no concussion has been diagnosed and therefore may resume full participation in learning and physical activity with no restrictions. My child has been examined and a concussion has been diagnosed and therefore must begin a medically supervised, individualized and gradual Return to Learn/Return to Physical Activity Plan. My child has been examined but I have chosen not to obtain medical authorization and give permission for my child to assume full participation in the learning and physical activity with no restrictions during the core instructional day. I understand that this does not include extra- curricular activities where there may be requirement for medical authorization, dependent on the nature of the extra-curricular activity. Parent/Guardian signature: ________________________________ Date: _____________________ Comments: ________________________________________________________________________________________ ________________________________________________________________________________________ ___________________________________________________________________________________________________________ Freedom of Information Notice The information provided on this form is collected pursuant to the Board’s education responsibilities as set out in the Educa tion Act and its regulations. This information is protected under the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) and will be utilized only for the purpose of managing student learning and well being. Access to this information will be limited to those who have an administrative need, to the student to whom the information relates and the parent(s)/guardia n (s) of a student who is under 18 years of age. Any questions with respect to this information should be directed to the school principal. I understand that the Ottawa-Carleton District School Board recommends my child receive medical attention. 