Forms and Other Posted Documents
There are a variety of forms available to help keep track of seizures and other information about a child’s condition. The following are a selection of such forms. All the documents posted on this page are ADA accessible (Section 508). The logs and forms have interactive form fields and are tagged for accessibility. Download the FREE Adobe Reader! Adobe Reader allows you to fill out the form electronically, but you cannot save it to your computer; you will only be able to print out the document.
Seizure Log
This is a form to keep track of a child’s seizure activity. Notes on this form can help health care providers understand more about how to treat your child’s seizures.
Seizure Description Sheet
Doctors will probably never see a seizure when it happens. They will need information from parents about what it looks like. This is a form with pictures to mark things you see. It will help a neurologist to understand your child’s seizure.
Seizure Action Plans
- What is a Seizure Action Plan?
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Every school-age child who has seizures should have a Seizure Action Plan on file at school. It helps school staff and medical providers know what to do and what not to do. Talk with school staff and your medical providers about what form(s) would be best for your school. Some school districts may have already chosen or created a standard form.
Below is the Seizure Action Plan form and other useful tools published by the National Epilepsy Foundation.
School nurses from Washington modified the National Epilepsy Foundation form to make it more school friendly. It collects the same information in a different order. It has a place for a picture of the child, which can be helpful in school.
Doctor Visit Notes & Tips
This helps to prepare for a visit to the doctor and to bring information home after the visit.
Download Doctor's Notes & Tips
My Child’s Profile
This is a place to record information you will probably need for every doctor’s office.
Medication Log
This is a chart to keep information together about all the medications and other things your child takes, and the instructions for them. It is useful to take to visits with medical providers.
Encounter Log
This form helps to keep track of contacts with and results of medical and other services.
J. Kiffin Penry Patient Travel Assistance Fund
This is a fund of the Epilepsy Foundation that offers a limited number of travel assistance grants to families. A family can receive up to $1,500 to help cover travel expenses for specialized epilepsy care or testing. More detail about rules and eligibility are in the application.
Legal Rights of Children with Epilepsy in School & Child Care
This is a 182-page manual published by the Epilepsy Foundation. It covers in detail the legal rights of children with epilepsy in school and childcare settings.
Epilepsy & Seizure Disorders: A Resource Guide for Alaska’s Parents
A fully accessible version of the Epilepsy & Seizure Disorders: A Resource Guide for Alaska’s Parents. The forms would be best downloaded from this page instead of used from the guide.
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