Need to update your Seizure Preparedness Plan?

Whether for a child/teen or for an adult, each Seizure Preparedness Plan has been especially designed to include all the forms you need to complete your plan. However, at times, you and your healthcare provider may want to update information in your plan.

Choose the page you need to update below:

INDIVIDUAL FORMS
Medical History and Physician Prescribed Emergency Seizure Treatment Order (Child/Teen)

Medical History and Physician Prescribed Emergency Seizure Treatment Order (Adult)

Step-by-Step Seizure Treatment Plan (Child/Teen and Adult)

Plan-at-a-Glance Wallet Cards (Child/Teen and Adult)

Seizure Log Cards (Adult)

Student Interview Form (Child/Teen)

Seizure Record (Child/Teen)

DIASTAT® AcuDial™ (diazepam rectal gel) Administration Instructions

Still haven't put your plan in Seizure Preparedness Plan in place? Download the plan that is right for you:

Child/Teen Seizure Preparedness Plan

Adult Seizure Preparedness Plan


Don't Miss – Also Read:
 
IMPORTANT SAFETY INFORMATION

DIASTAT® AcuDial™ (diazepam rectal gel) is a gel formulation of diazepam intended for rectal administration in the management of selected, refractory patients with epilepsy, on stable regimens of AEDs, who require intermittent use of diazepam to control bouts of increased seizure activity for patients 2 years and older.

In clinical trials with DIASTAT®, the most frequent side effect was somnolence (23%). Less frequent adverse events reported were dizziness, headache, pain, vasodilation, diarrhea, ataxia, euphoria, incoordination, asthma, rash, abdominal pain, nervousness and rhinitis (1%-5%). Please see full DIASTAT AcuDial Prescribing Information.