Get New Onset Seizure Clinic Screening Form - Ssm Cardinal Glennon ...

Filling out the New Onset Seizure Clinic Screening Form is an essential step for families seeking evaluation and care for their child's seizure symptoms. This guide provides a clear, step-by-step approach to help users complete the form accurately online, ensuring all necessary information is submitted for effective evaluation.

Follow the steps to accurately complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your editing tool.
2. Begin by filling in the child’s name and date of birth in the designated fields. Ensure correct spelling and accurate dates.
3. Next, enter the referring physician's name, parent contact phone number, and physician fax number in their respective sections.
4. Indicate the date of request to keep a record of when the referral was made.
5. Respond to the question about the timing of the neurological symptoms by selecting either yes or no for whether symptoms have occurred within the last four weeks.
6. If the onset was greater than four weeks ago, specify an approximate duration for when the first spell began.
7. Describe the exact nature of the spells in detail, addressing each symptom with a yes or no answer regarding their presence. Include symptoms like eye fluttering or tongue biting as specified.
8. Provide answers regarding any other associated features with the spells and specify if there are more than one kind of spell.
9. Answer questions about post-event symptoms and spell frequency by detailing how often these occur, including triggers and duration.
10. Indicate whether investigations such as EEG or MRI have been conducted, and attach copies of all relevant documents that support the referral.
11. Finally, confirm if the patient has previously been evaluated by a neurologist.
12. Once all fields are completed and double-checked for accuracy, save your changes. You can then download, print, or share the completed form as needed.

Complete the New Onset Seizure Clinic Screening Form online today to ensure timely care for your child.