Epilepsy and Narcolepsy

Name:	SSN:
Date of Exam:	C-number:
Place of Exam:

A. Review of Medical Records:

B. Medical History (Subjective Complaints):

Comment on:

1. Discuss precipitating factors, aggravating factors, alleviating factors.
2. Current treatment, response, side effects.
3. State the frequency and type of seizures or episodes of narcolepsy during the past 12 months, including any change in frequency pattern. If possible, record the actual number of seizures in each calendar month. If the veteran keeps a seizure diary, record dates of seizures.
4. Discuss the effect of epilepsy or narcolepsy on daily activities, including the effects of medications.

C. Physical Examination (Objective Findings):

1. Order a psychiatric examination if there are indications of a mental disorder associated with epilepsy.

D. Diagnostic and Clinical Tests:

1. Include results of all diagnostic and clinical tests conducted in the examination report.

E. Diagnosis:

1. If the diagnosis is NOT established or is questioned, schedule any necessary special studies, including admission for a period of examination and observation, as appropriate to provide a definitive diagnosis.

Signature:

Date: