About Medpage Epilepsy Monitors Please Read

Currency Selector

Quick Talker 12Long Range Pendant & Pager Kit

View Full-Size Image	Epilepsy & Seizure Evaluation Form
	Price per Unit (piece): Call for Pricing
	Ask a question about this product
	Epileptic Nocturnal Seizure Detection Monitor Evaluation *Click Here for email version* Call us on 1890 344 344 and we can email or post the form to you Or Copy text below and email it back to us with the questions filled in to info@homecaretechnologies.ie All information recieved is confidential Before Purchasing we ask you to fill out answers for the questions below so we can get the right monitor for you. Patient reference: Date ( ) What is the age of the patient? ( ) What is the weight of the patient? ( ) Has the patient been diagnosed with epilepsy? ( ) Does the patient have learning disabilities? ( ) Does the patient have any other medical conditions? ( ) Are there any reference records of seizure activity? ( Does the patient experience Tonic/Clonic seizures? ( ) Does the patient experience limb movement during a seizure? (whole body shaking, arms and or legs moving). ( ) How long do the seizures typically last? ( ) Does the patient vocalize preceding or during a seizure? ( ) If a radio link alarm is to be used, a pager for example, what is the maximum distance the pager could be away from the monitor? ( ) Are any other types of monitors used with the patient, a baby monitor, heart or respiration monitor? ( ) What type of bed does the patient sleep on? Please describe the bed in detail (single, double, king-size, solid bed base, slatted base, profiling) including the type and size of mattress (if a sprung type, memory foam, pressure relieving etc.). ( )