Seizure Plan and Protocol Form

* = Required Information

Individual: *

Types of seizures:

Describe Ttpical seizure:

Length of typical eizure:

Seizure frequency:

PLAN OF CARE:

1. Follow general seizure care and First Aid guidelines for seizures.
2. Anti-convulsant medications will be administered if prescribed.
3. All seizures will be documented on a Seizure Report including date, time, length of seizure, specific body movements and behaviors exhibited during the seizure, and post-seizure state.

SEIZURE PRECAUTIONS:

SEIZURE PROTOCOL:

Call 911 if:

Physician Name: *

Date: *