Get Seizure Protocol Form

This guide provides clear instructions on how to complete the Seizure Protocol Form for students with uncontrolled seizure disorders. By following these steps, you can ensure that the form is filled out accurately and efficiently.

Follow the steps to fill out the Seizure Protocol Form online

1. Press the ‘Get Form’ button to access the Seizure Protocol Form and open it for editing.
2. Begin by entering the student's name in the designated field. This is crucial for identifying the individual the protocol is for.
3. Fill in the date when the form is being completed, ensuring it reflects the current date for record-keeping.
4. Input the student's date of birth accurately to verify their identity and age.
5. Select the school the student attends from the provided options, as this will help tailor the protocol to their specific educational environment.
6. Enter the teacher's name, which is necessary for coordinating care and communication regarding the student.
7. In the physician's section, provide the diagnosis of the seizure disorder. Specify the type of seizure disorder to give context for treatment.
8. Detail the tolerated seizure activity, including the time frame and the expected number of seizures, which is important for monitoring the student’s condition.
9. Clearly outline the criteria for notifying emergency medical services, parents, the school nurse, and health services. This ensures everyone knows when to take action.
10. List the necessary interventions that need to be taken should a seizure occur, providing step-by-step guidance for staff.
11. Document any medications that the student is currently taking, including the dosage, route of administration, and frequency to ensure proper management.
12. Include any additional comments that could assist in the management of the student's condition, taking into consideration any unique circumstances.
13. Complete the physician’s signature and provide the fax number, phone number, and address to ensure authenticity and contact information for follow-up.
14. Ensure the parent or guardian signs the form with their city, state, and zip code for verification.
15. After completing all fields, save changes to the form, and choose to download, print, or share it as needed.

Begin completing the Seizure Protocol Form online now to ensure that all necessary information is recorded efficiently.