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SEIZURE ACTION PLAN (SAP) - Epilepsy Foundation

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When rescue therapy may be needed:WHEN AND WHAT TO DO If SEIZURE (cluster, # or length) ________________________________________ ________________________________Name of Med/Rx ________________________________ How much to give (dose) ________________________How to give ________________________________________ ________________________________________ _____If SEIZURE (cluster, # or length) ________________________________________ ________________________________Name of Med/Rx ________________________________ How much to give (dose) ________________________How to give ________________________________________ ________________________________________ _____If SEIZURE (cluster, # or length) ________________________________________ ________________________________Name of Med/Rx ________________________________ How much to give (dose) ________________________How to give ________________________________________ ________________________________________ _____Name: Birth Date: Address: Phone: Emergency Contact/Relationship Phone: SEIZURE ACTION PLAN (SAP)How to respond to a SEIZURE (check all that apply) FFirst aid Stay.

until recovered from seizure F Swipe magnet for VNS F Write down what happens Person does not return to usual behavior (i.e., confused for a _____ F Other _____

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