Patient Case | Adults - Project ECHO Epilepsy Ontario

Your Name *

First

Last

Your Email *

Your Clinical Site *

Patient Age *

Patient Sex *

Current Issues/ History of Presenting Illness with Description of Event[s] *

Current Medications *

Past Medical/ Neurological/ Seizure History *

Social/Personal History, Current Functioning (i.e. working, dropped out of school) *

Family History *

Investigations [EEG, Neuroimaging, Other] *

Questions for ECHO *

Family and Patients' goals? *

Considering your clinical experience with this patient, rate how ill they are as described in the case form. **Ill can reflect the severity of the seizures/events or the impact on the patient and family** *