NYSCSH Diastat Administration Reporting Form
This form provides NYSCSH with data on Diastat administration in schools. It is completed on-line and a copy may be printed for the school nurses records.
Provides information on Diastat medication and how to administer it.
Emergency Care Plans (ECP) and Parent Questionnaire
Diastat™/Seizure Preparedness Plan -Links to Diastat™ website. Provides resources and information for creating a seizure emergency plan.
Epilepsy Foundation Emergency Care Plan-Provides information for emergency management in both English and Spanish.
Seizure ECP- Customizable template for health care provider to document type of seizure and treatment plan. Separate medication order would be needed. Revised 9/12
NYSCSH Seizure ECP with Medication Information-Customizable template for health provider to document recommended response plan for seizures. Includes area for medication and Vagal Nerve Stimulator orders. Revised 9/12
NYSCSH Parent Interview Questionnaire for Seizure History - Provides recording sheet for parent to share students seizure history including presentation, frequency, medications and students current understanding of the condition. 6/12
Epilepsy Foundation/Epilepsy Therapy Project Resources
Children at School and Childcare-Provides information and resources (forms, communication tools, training, educational rights and impact on learning) for parents, schools and day cares on effectively and safely caring for students with seizures.
Managing Students with Seizures: School Nurse Training Program-Provides school nurses with information and resources to better manage the student with seizures. The program is divided into three parts to assist the school nurse in learning to effectively manage seizures in a school environment.
Seizures and You: Take Charge of the Facts is an epilepsy awareness program for teens in high school to dispel myths and reduce the perceived stigma associated with epilepsy within the teen population.
504 Plan-Sample plan from Epilepsy.com
School Activity Management Tools
Sample Seizure Management Guidelines.
Sample Seizure Management Guidelines for Student Participation In School and School Sponsored Activities- Provides sample guidelines for provider restriction of student activity based on the students seizure history. It was developed by the University of Rochester Medical Center, Department of Child Neurology and the Committee on School Health and Sports Medicine for Chapter I of District II of AAP.This information may be used as a guide for district medical directors when discussing appropriate accommodations for students with their private health care providers and developing plans for safe school participation. 9/2015
Seizure Observation/Recording Forms
These forms can be used to record seizures. They include calendars, diaries and logs from Epilepsy/com
Vagal Nerve Stimulator
Vagal Nerve Magnet Stimulator - NYSED Office of Professions (Memo dated 1-25-07)
"Unlicensed persons may apply this technique in school settings provided that such persons understand the particular child’s seizure patterns and are trained in the proper technique and potential side effects."
Page updated 11/14/16