TerraBlue XT - TJay Suite

Collapses

1) When did this happen?

2) What happened before the collapse?(headache,nausea)

3) Did you know you were going to lose consciousness?

No Yes

4) How long does it last?

5) Did you hurt yourself by hitting anywhere?

No Yes

6) What were you doing at that time? (watching TV,exerise,standing up,walking,passing urine etc)

7) Were there any visual or sensory changes?

No Yes

8) Did you wet yourself?

No Yes

9) How did you feel when you recovered? (Confused, tired etc)

Epilepsy

1) Age When First Seizure Occured

2) Circumstances During first Seizure

Please elaborate your first seizure.Input information like how it occurred, how much time did it last, how long did you take to recover and other details you remember.

3) Family History Of Seizures

Please mention if any person in your family suffers from seizures and indicate your relationship with the person

Seizure	What happend during Seizure	How long it Lasted	How much time did you take to recover	Duration since he is on medicine
Seizure 1
Seizure 2
Seizure 3
Seizure 4
Seizure 5

4) Are There Any Medicine You Are Taking Now

No Yes

Name of Medicine	Total Daily Amount in No of Tablets	Amount in TBSP	Total Doses taken in a day

5) How Frequently Does The Seizure Occurs

Please mention how frequently does the seizure occurs

6) How Long Does The Seizure Last

7) How Long Does It Take For You To Recover

Please indicate how much time you take to recover fully from the seizure or the time you take to come to normal

8) Specific Time In The day When Seizure Occurs

Indicate the time when you normally get seizure

10) Mention Other Triggers You Experience

12) Mention Any Other Aura You Exerience

13) Have you undergone any surgeries for epilepsy?

No Yes Relative

14) Surgery Details

Please mention if you have undergone any surgeries

15) Are you using any medical device at this moment?

No Yes

16) Device Type

17) Model No Of Device

18) Serial No Of Device

19) Date On Which The Device Was Implanted

20) Are You Currently On Any Dietery Therapy

21) Any Other Therapy

Mr. Vinod Sharma
DOB: 01/01/1978 (Age 37), Male

+91 97420 56787

Chat

Video Call

Symptom Checker

Collapses

Dizziness

Eyesight

Hearing

Transient Loss of Function (Vision, Speech, Sight)

Paraesthesia

Epilepsy

Mr. Vinod Sharma DOB: 01/01/1978 (Age 37), Male +91 97420 56787 Chat Video Call

Symptom Checker

Collapses

Dizziness

Eyesight

Hearing

Transient Loss of Function (Vision, Speech, Sight)

Paraesthesia

Epilepsy

Mr. Vinod Sharma
DOB: 01/01/1978 (Age 37), Male

+91 97420 56787

Chat

Video Call