Seizure Classification Sheets
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Name CHI number Seizure Classification Sheets Seizure name Seizure type A Describe any possible triggers to this type of seizure:
What time of day does this type tend to happen?
Describe any behavioural changes that occur in the lead up to the seizure (including duration, e.g. days, hours):
Describe any warning (aura) prior to seizure:
Description (including USUAL duration of each part of seizure, eg 2-3 minutes and colour change or change in breathing pattern throughout the seizure):
Describe any action that requires to be taken at this stage:
Describe usual recovery, including usual duration:
Describe action to be taken as they recover:
Completed by: Name:...... Job Title: ...... Date: ...... Validated by: Name:...... Job Title: ...... Date: ...... (Clinician)
This documentation has been produced by the West of Scotland & Tayside Epilepsy MCN (Dec ’08) Page ..... Guidance on completion & copies of all care planning documentation are available at www.epilepsytoolbox.scot.nhs.uk Name CHI number Seizure Classification Sheets Seizure name Seizure type B Describe any possible triggers to this type of seizure:
What time of day does this type tend to happen?
Describe any behavioural changes that occur in the lead up to the seizure (including duration, e.g. days, hours):
Describe any warning (aura) prior to seizure:
Description (including USUAL duration of each part of seizure, eg 2-3 minutes and colour change or change in breathing pattern throughout the seizure):
Describe any action that requires to be taken at this stage:
Describe usual recovery, including usual duration:
Describe action to be taken as they recover:
Completed by: Name:...... Job Title: ...... Date: ...... Validated by: Name:...... Job Title: ...... Date: ...... (Clinician)
This documentation has been produced by the West of Scotland & Tayside Epilepsy MCN (Dec ’08) Page ..... Guidance on completion & copies of all care planning documentation are available at www.epilepsytoolbox.scot.nhs.uk Name CHI number Seizure Classification Sheets Seizure name Seizure type C Describe any possible triggers to this type of seizure:
What time of day does this type tend to happen?
Describe any behavioural changes that occur in the lead up to the seizure (including duration, e.g. days, hours):
Describe any warning (aura) prior to seizure:
Description (including USUAL duration of each part of seizure, eg 2-3 minutes and colour change or change in breathing pattern throughout the seizure):
Describe any action that requires to be taken at this stage:
Describe usual recovery, including usual duration:
Describe action to be taken as they recover:
Completed by: Name:...... Job Title: ...... Date: ...... Validated by: Name:...... Job Title: ...... Date: ...... (Clinician)
This documentation has been produced by the West of Scotland & Tayside Epilepsy MCN (Dec ’08) Page ..... Guidance on completion & copies of all care planning documentation are available at www.epilepsytoolbox.scot.nhs.uk Name CHI number Seizure Classification Sheets Seizure name Seizure type D Describe any possible triggers to this type of seizure:
What time of day does this type tend to happen?
Describe any behavioural changes that occur in the lead up to the seizure (including duration, e.g. days, hours):
Describe any warning (aura) prior to seizure:
Description (including USUAL duration of each part of seizure, eg 2-3 minutes and colour change or change in breathing pattern throughout the seizure):
Describe any action that requires to be taken at this stage:
Describe usual recovery, including usual duration:
Describe action to be taken as they recover:
Completed by: Name:...... Job Title: ...... Date: ...... Validated by: Name:...... Job Title: ...... Date: ...... (Clinician)
This documentation has been produced by the West of Scotland & Tayside Epilepsy MCN (Dec ’08) Page ..... Guidance on completion & copies of all care planning documentation are available at www.epilepsytoolbox.scot.nhs.uk Name CHI number Seizure Classification Sheets Seizure name Seizure type E Describe any possible triggers to this type of seizure:
What time of day does this type tend to happen?
Describe any behavioural changes that occur in the lead up to the seizure (including duration, e.g. days, hours):
Describe any warning (aura) prior to seizure:
Description (including USUAL duration of each part of seizure, eg 2-3 minutes and colour change or change in breathing pattern throughout the seizure):
Describe any action that requires to be taken at this stage:
Describe usual recovery, including usual duration:
Describe action to be taken as they recover:
Completed by: Name:...... Job Title: ...... Date: ...... Validated by: Name:...... Job Title: ...... Date: ...... (Clinician)
This documentation has been produced by the West of Scotland & Tayside Epilepsy MCN (Dec ’08) Page ..... Guidance on completion & copies of all care planning documentation are available at www.epilepsytoolbox.scot.nhs.uk