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Legal Rights of Children with Epilepsy in School & Child Care

Legal Rights of Children with Epilepsy in School & Child Care

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(STUDENT’S NAME) REPORT FROM HOME DATE<br />

Physical:<br />

Seizures: Yes___ No___<br />

If yes, # <strong>of</strong> seizure episodes_________<br />

Time seizure(s) occurred____________________<br />

Length <strong>of</strong> seizure episode(s)___________<br />

Type(s) <strong>of</strong> seizure(s)__________________________________________<br />

Sleep afterwards? Yes___ No____<br />

Emergency medication used: Yes/Type _______________________________ No_____<br />

Other care provided____________________________________<br />

Additional <strong>in</strong>formation:<br />

Concerns/Questions:<br />

Contact Information for Today: ____________________ _________________<br />

Name<br />

Telephone Number<br />

Back-up Contact Person for Today: ___________________<br />

Name<br />

__________________<br />

Telephone Number<br />

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