Seizure Emergency Care Plan (Page 2 of 4) in pdf

Seizure Emergency Care Plan Page 2

CONTACT INFORMATION

Parent/Guardian: _______________________________________________________________

Telephone: Home: __________________ Work: __________________ Cell: ______________

Health Care Provider: ___________________________________________________________

Address: ______________________________________________________________________

Telephone: ________________________________ Emergency: _________________________

Other Emergency Contact: _______________________________________________________

Relationship: __________________________________________________________________

Telephone: Home: ____________________ Work: _________________ Cell: _____________

Seizure Documentation Chart

(Documentation to be completed by the witness observing the seizure.)

Date

Time of

Length of

Observations/Comments

Day

Seizure

*Please note unusual behavior just prior to seizure. During seizure note parts of the body with

movements such as head, eyes, body, mouth and extremities and describe the type of

movement. After seizure, observe for breathing, color of skin, incontinence, drowsiness,

confusion or injuries.

Seizure Emergency Care Plan Page 2