MODULE 3: Epilepsy Support and Non-medication Management 38 As-needed Treatments Treatment Name (for example, vagus nerve stimulator [VNS] magnet, specific medication) When to Give Amount to Give How to Give Call 911 or Seek Emergency Help In Any of the Following Situations Generalized seizure that lasts longer than 5 minutes, unless otherwise noted on this form in the “When Seizures Require Additional Help” section above 2 or more seizures without recovering between seizures If “As-needed” treatments listed on this form don’t work Injury occurs or is suspected, or seizure occurs in water Breathing, heart rate, or behavior doesn’t return to normal Unexplained fever or pain that happens hours or a few days after seizure Other emergency care needed for this person: Healthcare Contacts Epilepsy Doctor Phone Primary Care or Other Healthcare Provider Phone Preferred Hospital Phone Pharmacy Phone Special Instructions My Signature Date Healthcare Provider Signature Date 1. Epilepsy Foundation. Seizure Response Plans 101. http://www.epilepsy.com/get-help/managing-your-epilepsy/seizure-response-plans-101. Published August 2013. 2. Epilepsy Foundation of Michigan. Community Education. http://www.epilepsymichigan.org/page.php?id=334. 2011. 3. Epilepsy Foundation. My Seizure Plan. http://www.epilepsy.com/sites/core/files/atoms/files/myseizureplan.pdf. 2007. 4. Epilepsy Foundation. Seizure Action Plan. http://epilepsy.prod.acquia-sites.com/sites/core/files/atoms/files/seizure-action-plan-pdf_0.pdf. 2008.