Return-to-Learn/School Accommodation Letter (Concussion)

Date: [date of letter]

Student: [full name], DOB [date of birth], Student ID [student ID if applicable]

Parent/Guardian: [name(s) if minor]

To: [school name], Attn: School Nurse / Concussion Management Team

From: [provider name, credentials, clinic name, phone/fax]

RE: Return-to-Learn / School Accommodations (Concussion)

Confidentiality: This letter contains protected health information intended only to support school accommodations. Share only with personnel who need it to implement supports.

Clinical Summary

Clinical status: [Diagnosed concussion / Suspected concussion (treat as concussion pending reassessment) / Post-concussion symptoms continuing]

Date of injury: [date of injury / injury date unknown] | Date of evaluation: [date of clinical evaluation]

[Brief functional summary of current recovery phase (acute / improving / persistent), primary school-relevant impacts such as headaches with reading, light/noise sensitivity, fatigue, or slowed processing, and symptom trend (stable / improving / worsening)] (Use plain language in 2–4 sentences. State any limitations in available information without inferring clinical status.)

Academic Accommodations

[Symptom-informed accommodations addressing relevant domains: attendance/schedule, environmental supports for sensory sensitivities, workload adjustments, testing modifications, and screen/technology use as applicable] (Tailor to this student's current symptoms and functional limitations. Use brief narrative or short list. Do not include accommodations that are not clinically indicated.)

Stop-rule: If symptoms meaningfully worsen during any activity, the student should stop, rest in a quiet area, and resume later at a reduced level.

Authorization period: Through [date], then reassess. (If symptoms persist beyond 2–4 weeks or the student falls significantly behind, coordinate with family and clinician regarding formal support mechanisms.)

Physical Activity Restrictions

Current restrictions: [Contact/collision activities, PE activities with fall or head-impact risk, and competitive sports: specify what is restricted vs. permitted]

Permitted activity level: [symptom-limited walking / modified non-contact PE / full restriction / other]

(If athlete or PE participant:) Staged return-to-physical-activity: advance only when no new or worsening symptoms at current level, minimum 24 hours per stage, step back if symptoms return. Full clearance for unrestricted sport/PE requires clinician authorization. Return-to-learn should be substantially achieved before unrestricted return-to-sport.

Follow-Up and Communication

Planned follow-up: [follow-up date or interval]. Follow up sooner if symptoms worsen.

Contact clinician if: Worsening symptoms at school, inability to tolerate progression despite supports, symptoms persisting beyond expected timeframe, or any concerning neurologic changes.

Emergency warning signs (call 911 and notify parent/guardian): Worsening/severe headache, repeated vomiting, seizure, confusion or unusual behavior, difficulty waking, weakness/numbness/slurred speech, or other focal neurologic deficits.

Closing

Please contact our clinic with questions: [preferred contact method]

Sincerely,

[provider printed name, credentials]
[clinic name, address, phone/fax]