Section 201.010 - Exclusion from Play(A) Any student, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion, or loses consciousness, even briefly, shall be removed from the practice or competition immediately and may not return to the practice or competition that day.(B) The student shall not return to practice or competition unless and until the student provides medical clearance and authorization as specified in 105 CMR 201.011.(C) The coach shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice or competition in which a student has been removed from play for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness. The coach also must provide this information to the parent in writing, whether paper or electronic format, by the end of the next business day.(D) The coach or his or her designee shall communicate, by the end of the next business day, with the Athletic Director and school nurse that the student has been removed from practice or competition for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness.(E) Each student who is removed from practice or competition and subsequently diagnosed with a concussion shall have a written graduated reentry plan for return to full academic and extracurricular athletic activities.(1) The plan shall be developed by the student's teachers, the student's guidance counselor, school nurse, licensed athletic trainer if on staff, neuropsychologist if available or involved, parent, members of the building-based student support and assistance team or individualized education program team as appropriate and in consultation with the student's primary care provider or the physician who made the diagnosis or who is managing the student's recovery.(2) The written plan shall include instructions for students, parents and school personnel, addressing but not be limited to:(a) Physical and cognitive rest as appropriate;(b) Graduated return to extracurricular athletic activities and classroom studies as appropriate, including accommodations or modifications as needed;(c) Estimated time intervals for resumption of activities;(d) Frequency of assessments, as appropriate, by the school nurse, school physician, team physician, licensed athletic trainer if on staff, or neuropsychologist if available until full return to classroom activities and extracurricular athletic activities are authorized; and(e) A plan for communication and coordination between and among school personnel and between the school, the parent, and the student's primary care provider or the physician who made the diagnosis or who is managing the student's recovery.(3) The student diagnosed with a concussion must be completely symptom free at rest in order to begin graduated reentry to extracurricular athletic activities. The student must be symptom free at rest, during exertion, and with cognitive activity in order to complete the graduated re-entry plan and be medically cleared to play under 105 CMR 201.011.Amended by Mass Register Issue 1266, eff. 8/1/2014.