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DATE NAME OF PERSON COMPLETING FORM AND STAFF POSITION When did the seizure start AM PM When did the seizure end AM PM Rapid jerking body movements Body limbs stiffened and shaking began Right side of body only Left side of body only Jerking of the face or limbs that lasted more than a second or two Student cried/squealed out Student made gurgling or grunting noises Student fell to ground and had a seizure and injured self Student fell to ground and had a seizure no.

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