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This is probably a state-by-state thing.
In MN, we're told that, if we send a player out because of concussion-like symptoms, they cannot return until cleared by a "certified health care professional". Since we don't know who the "certified health care professional" in the gym is, if anyone, we're told that it's the coaches responsibility to ensure that their player has been cleared by said professional. If the player returns after being sent off, the officials are told to assume that the player has been cleared to return. (Of course, we can send them off again if we notice concussion-like symptoms again.)
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