The Process to Follow when there is a Potential Head Injury (Follow the Flow Chart)
1. When there is a possibility of a potential head injury or potential concussion, the Player is immediately removed from ALL Phoenix Rising FC Youth Soccer activities. In order for any Player to return to practices, games, or team activities, they will have to be seen and cleared by a Medical Doctor (MD) or Doctor of Osteopathy (DO) with the Club supplied paperwork completed, signed, and turned in. This includes potential head injuries or potential concussions where ever they may have occurred (Examples: at home, during high school soccer, ODP, when traveling) even if it was not at or representing Phoenix Rising FC Youth Soccer activities.
2. Immediately notify the Phoenix Rising FC Youth Soccer VP of Competitive, Brad Clement, at bradc@prfcyouthsoccer.com of the potential injury. Notification must be made immediately as there are insurance timelines and specialist care options available to injured Players should they choose to utilize them. Please include in the notification email:
- The Player’s Complete Name
- The Player’s Complete Team Name
- The Date / Place / Time of the Potential Injury
- The Contact Information (Names, Emails, & Cell Phones) of the Player’s Parents
- The Team Coach’s Name and Email
- The Particulars and Circumstances of the Player’s Potential Injury
3. Upon notification, the Parent(s) will receive the Phoenix Rising FC Youth Soccer Concussion Injury Packet. The Parent(s) should print it out and bring it to all of the Player’s medical appointments. You will need to have the Medical Doctor (MD) or Doctor of Osteopathy (DO) complete (initial and sign) the appropriate section(s) of the Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form at each appointment. You will need the Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form at each step throughout the process in order for the Player to begin soccer activities again.
4. Upon notification, the Parent(s) will also receive a Supplemental Concussion Insurance Claim Form if the potential concussion injury occurred during Phoenix Rising FC Youth Soccer approved events. Phoenix Rising FC Youth Soccer provides this supplemental insurance to all of our Phoenix Rising FC Youth Soccer Competitive Program Players. It works as a supplemental policy to the family’s primary insurance, has no deductible, and a $25,000 yearly limit. The Phoenix Rising FC Youth Soccer Concussion Injury Packet includes a Healthcare Provider Letter to submit to any medical provider they see to activate the billing portion of the policy. The Parent(s) must fill out the Supplemental Concussion Insurance Claim Form, every question and every box in all sections, in its entirety and submit it themselves to The Hartford or through our Broker using the postal mail, FAX, and email address listed on that form. You have ninety (90) calendar days from the date of the incident to submit the claim form and the Club Administrator must sign and date the form.
IMPORTANT: Please confirm insurance information with all providers you work with to manage coverage and expectations when an injury situation occurs. Always ask your provider(s) what procedures / therapies / services / facilities / transportation may or may not be covered by this insurance as this insurance is a supplemental (limited pay) policy and does not cover all procedures / therapies / services / facilities / transportation. Only the procedures / therapies / services / transportation that are considered standardly accepted medical treatment, non-experimental, may be covered with this policy. Emergency room visits and transportation may or may not be covered by this policy.
5. Phoenix Rising FC Youth Soccer has a working relationship with the Banner Concussion and Sports Medicine Center and they are specialists that deal with concussion injuries and concussion treatment. They are very familiar with Phoenix Rising FC Youth Soccer athletes and our supplemental insurance program. Their information is also located within the Phoenix Rising FC Youth Soccer Concussion Injury Packet and on our Club website, www.prfcyouthsoccer.com, in the “Concussion Program” section, should you choose to use their medical services or would like to contact them with questions or for more information. You are under no obligation or requirement to use their services and are free to choose the medical provider(s) that fit your family’s needs and insurance.
6. If the Medical Doctor (MD) or Doctor of Osteopathy (DO) concludes that the Player HAS NOT suffered a concussion and the Player can return to athletic activities without restrictions, the Medical Doctor (MD) or Doctor of Osteopathy (DO) notates the finding, with the return date, in the Initial Evaluation Section of the Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form and signs the form. The family brings the signed Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form back to their Coach at practice and submits a copy, via email, to the Phoenix Rising FC Youth Soccer VP of Competitive, Brad Clement, at bradc@prfcyouthsoccer.com and to Polly Robinson, the Club Registrar, at pollyrobinson1997@gmail.com. This signed and dated form must be received by Brad Clement before a Player will be allowed to return to any normal activities and games with the Club. The Player can then resume practice / game / team activities as advised by the Medical Doctor (MD) or Doctor of Osteopathy (DO) once the paperwork has been received and evaluated by Brad Clement. This concludes the process.
7. If the Medical Doctor (MD) or Doctor of Osteopathy (DO) concludes that the Player HAS suffered a concussion, the Medical Doctor (MD) or Doctor of Osteopathy (DO) notates the finding, with a follow-up appointment date, in the Initial Evaluation Section of the Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form and signs the form. The family keeps the Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form and uses it to notate the Follow-Up Evaluation Section at each follow-up appointment and throughout the treatment process. Depending on the individual and the severity of the concussion, this process can take a significant amount of time and encompass multiple follow-up visits with a provider.
8. When the Medical Doctor (MD) or Doctor of Osteopathy (DO) concludes that the Player has reached the second box in the Follow-Up Evaluation Section on the Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form, the Medical Doctor (MD) or Doctor of Osteopathy (DO) is stating that the Player is ready to return to a segmented and sequential level of activity by following the Phoenix Rising FC Youth Soccer Return to Play Progression (5 Stages), startingwith Stage 1. This is NOT full medical clearance to return to any normal activities and games with the Club.
IMPORTANT: Players cannot start the Phoenix Rising FC Youth Soccer Return to Play Progression (5 Stages) until they are cleared to do so by their Medical Doctor (MD) or Doctor of Osteopathy (DO) and not before the date the Medical Doctor (MD) or Doctor of Osteopathy (DO) lists on the form. Each Stage will last a minimum of twenty-four (24) hours between each Stage without symptoms. If symptoms remain or occur, there is no advancement to the next Stage until there are twenty-four (24) hours between each Stage without symptoms.
On the Phoenix Rising FC Youth Soccer Return to Play Progression (5 Stages) Form, each Stage must be initialed by the adult who supervised its completion, the date the Stage was completed, and the location where the Stage was completed. To help in Player participation and compliance, all Stages should be administered during the Player’s normal practice schedule and at the practice location with their team, when appropriate. The Player’s Coach would communicate and / or set-up the appropriate Stage activities (walking, jogging, running, skill-work, etc . . .) for the Player to complete independently (Stage 1, 2 & 3), non-contact practice for the Player that is communicated to the team (Stage 4), and full contact, normal practice activities after medical clearance (Stage 5). Before reaching Stage 5, the Player must be seen by their Medical Doctor (MD) or Doctor of Osteopathy (DO) to be cleared to move on to Stage 5. Stage 4 and Stage 5 must be completed in a practice session. This may extend the Return to Play timetable if the Player’s practice session has been concluded for the week before reaching one or both of these Stages. Game warm-up is not an acceptable alternative to a practice session.
9. Only when the Stage 5 progression has been successfully completed will the Medical Doctor (MD) or Doctor of Osteopathy (DO) clear the Player, with a return to full athletic activity without restrictions date, in the third box of the Follow-Up Evaluation Section on the Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form and sign the form. The family brings the signed Phoenix Rising FC Youth Soccer Concussion Program: Physician Clearance Form AND the signedPhoenix Rising FC Youth Soccer Return to Play Progression (5 Stages) Form back to the Coach at practice and submits a copy, via email, to the Phoenix Rising FC Youth Soccer VP of Competitive, Brad Clement, at bradc@prfcyouthsoccer.com and to Polly Robinson, the Club Registrar, at pollyrobinson1997@gmail.com. This signed and dated form must be received by Brad Clement before a Player will be allowed to return to any normal activities and games with the Club. The Player can then resume practice / game / team activities as advised by the Medical Doctor (MD) or Doctor of Osteopathy (DO) once the paperwork has been received and evaluated by Brad Clement. This concludes the process.
