Medical Note Requirements

Medical notes must be specific enough for the team Trainer to apply safely.

For injury-related return to play, medical documentation must clearly identify:

1. The specific injury or condition being assessed
2. Whether the player has recovered or is medically appropriate to progress
3. The level of hockey activity permitted, such as:
   • Off-ice activity only
   • On-ice skating only
   • Non-contact practice
   • Contact practice
   • Game play
4. Any restrictions, limitations, bracing, taping, or monitoring requirements
5. Whether a staged return-to-play progression is required
6. The date of assessment
7. The provider’s name, designation, clinic, and contact information

Who Can Sign Return-to-Play Notes

For return-to-play notes, Hockey Canada indicates that musculoskeletal injuries may be signed off by the player’s treating healthcare professional. Fractures, neurological injuries, spinal injuries, and concussions must be signed off by a physician.

Generic notes that only state a player “may return to sport,” “may return to activity,” “may return to hockey,” or “is cleared to play” may not be accepted if they do not identify the injury, the level of activity permitted, or any required restrictions.

Examples of Incomplete Medical Notes

A medical note may be considered incomplete if it:

1. Does not identify the injury or condition
2. Does not state whether the player was assessed for the specific injury
3. Does not explain whether the injury has resolved or improved
4. Does not specify contact vs. non-contact participation
5. Does not state whether the player may return to practice, contact practice, or game play
6. Does not include restrictions or progression requirements
7. Does not include the provider’s designation or clinic information
8. Does not align with the player’s observed presentation

If a note is incomplete, the team Trainer may request clarification before allowing the player to return. The team Trainer may contact the Trainer Coordinators for process support if the documentation remains unclear or disputed.

What to Do If the Medical Note is Incomplete

If a medical note is missing information or unclear, the team Trainer may request clarification or updated documentation before clearing the player to return.

When to Request Clarification: We require updated documentation if the note:

• Does not clearly identify the injury or condition.
• Fails to specify the level of hockey activity permitted (e.g., practice vs. game).
• Does not clarify if contact is allowed.
• Is inconsistent with the player’s observed symptoms or presentation.
• Is from a provider whose scope of practice does not align with the injury.

The Process:

1. Trainer Action: Review the note against the requirements above. If concerns remain, contact the parent to explain that additional detail is needed for safety.
2. Support: If the documentation remains unclear or the parent disputes the request, contact the Trainer Coordinators for assistance.
3. Safety First: Remember, medical notes do not override the Trainer's responsibility to ensure player safety. If the team Trainer has ongoing concerns, they are empowered to delay the return to play until those concerns are resolved.

Provider Appropriateness

The Trainer Program may consider whether the medical provider’s scope or practice area reasonably aligns with the injury, condition, and return-to-play decision.

For concussion clearance, documentation must meet the applicable concussion protocol. A provider may be qualified in their own field but may not meet the required standard for concussion return-to-contact clearance.

For non-concussion injuries, the medical documentation must still provide enough detail for the team Trainer to understand:

1. What injury was assessed
2. What level of hockey activity is permitted
3. Whether contact is allowed
4. Whether restrictions or staged progression are required

Medical Notes Do Not Override Safety Concerns

Medical clearance does not override observed safety concerns.

If a player presents with signs, symptoms, movement limitations, instability, pain, illness, or behaviour that is inconsistent with safe participation, the team Trainer may remove the player from activity and request further assessment before the player returns.

This applies even when a player has provided a medical note.