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Seizure Observation Log This form is designed to be used for general communication between direct care staff supervisory staff legal representatives and medical professionals to support the well-being of people who may experience a seizure. All sections should be completed for each seizure that occurs. Name of Person Age or Date of Birth Lastname please print Firstname please print Date Time Length of Seizure Observations seconds or minutes You can use numbers below Possible observations include 1. Sudden Stare 2. Unresponsive to name 3. Prompt recovery seconds 4. Sudden onset nausea 5. Vision problems 6. Jerking of a limb Recovery 7. Gradual recover minutes 8. Stiffening convulsive activity 9. Laboured breathing Comments if any Making the entry please print 10. All sections should be completed for each seizure that occurs. Name of Person Age or Date of Birth Lastname please print Firstname please print Date Time Length of Seizure Observations seconds or minutes You can use numbers below Possible observations include 1. Sudden Stare 2. Unresponsive to name 3. Prompt recovery seconds 4. Sudden onset nausea 5. Vision problems 6. Sudden Stare 2. Unresponsive to name 3. Prompt recovery seconds 4. Sudden onset nausea 5. Vision problems 6. Jerking of a limb Recovery 7. Gradual recover minutes 8. Stiffening convulsive activity 9. Laboured breathing Comments if any Making the entry please print 10. All sections should be completed for each seizure that occurs. Name of Person Age or Date of Birth Lastname please print Firstname please print Date Time Length of Seizure Observations seconds or minutes You can use numbers below Possible observations include 1. Sudden Stare 2. Unresponsive to name 3. Prompt recovery seconds 4. Sudden onset nausea 5. Vision problems 6. Jerking of a limb Recovery 7. Gradual recover minutes 8. Stiffening convulsive activity 9. Laboured breathing Comments if any Making the entry please print 10. .

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