ࡱ> ilh @bjbj 4`eeIDX,"f4(\\\tO|Q{!}!}!}!}!}!}!$#D&r!EOO!\t!!!!\t{!!{!!!!\xf!!g!!0,"!&!&!&!X!!!!,"& : Personal Alert Card Insert pupil photo  Name: Class: Date of Birth: School:  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      Emergency Contact NumbersName:  FORMTEXT      Home:  FORMTEXT      Mobile:  FORMTEXT      Name:  FORMTEXT      Home:  FORMTEXT      Mobile:  FORMTEXT      GP:  FORMTEXT      Number:  FORMTEXT      Nurse:  FORMTEXT      Work:  FORMTEXT      Mobile:  FORMTEXT      Specialist:  FORMTEXT      Work:  FORMTEXT      Treatment of Syptoms:  FORMTEXT       Special request from parents:  FORMTEXT       Parent/Carer signature Print Name:  FORMTEXT      Date:  FORMTEXT      Nurse signature Print name:  FORMTEXT      Date:  FORMTEXT      Head Teacher signature Print Name:  FORMTEXT      Date:  FORMTEXT      Discused with parent where alert card will be displayed  FORMCHECKBOX  classroom,  FORMCHECKBOX  staffroom,  FORMCHECKBOX  kitchens,  FORMCHECKBOX  office,  FORMCHECKBOX  other Medical Condition & Daily care requirements:  FORMTEXT       Care Requirments:  FORMTEXT       Special consideration for school trips:  FORM&(*LNP  " $ . 0 2 4 H J L V X tphxMjhI=Uj\hI=UjhI=UjthI=UjhI=UmHnHujhI=UjhI=UhI=he$Yh3CJaJhe$YCJaJhe$Yhe$YCJaJh<)CJaJh[hAT5CJph[hI=5CJp,(NPRx 2 Z $IfgdI=$If $$Ifa$gd3$$Ifa$gd3 $a$gd[ Z \ \P $$Ifa$gd[kd$$IflJ F 5& } t06    44 lapyty : $Ifgd[qkd$$Ifl5&& t0644 lap yty   ( * , 6 8 J L ` b d n p    " * , 6 8 L N P Z \ p r jhI=Uhj:hI=Uj hI=UjhI=UhxMj%hI=UjhI=UjhI=UmHnHujhI=UjhI=UhI=7: < r ^UUU $Ifgd[kdn$$IflF B5&   t06    44 lapyty $ ^ ^UU $Ifgd[kd$$IflF B5&   t06    44 lapyty^ ` vmmm $Ifgd[kd&$$Ifl0 5&  t0644 lapyty   & ( < > @ J L Z \ p r t ~   2 4 6 ڼڅzj hI=Uj hI=UjT hUjhUmHnHuj hUjhUhj hI=Uj; hI=UhxMhI=jhI=UmHnHujhI=UjhI=U0  N ^UUU $Ifgd[kd' $$IflF B5&   t06    44 lapyty ^PE99 $$Ifa$gd[ $Ifgd[$$Ifa$gd[kd $$IflF B5&   t06    44 lapyty  D F ~ui $$Ifa$gd[ $Ifgd[$$Ifa$gd[skd $$Iflx5&& t0644 lap yt6 @ B *.0DFHRT`dfz|~$&(248hxMjh[Ujh[Ujh[Ujh[Ujh[Ujh[UmHnHujh[Ujh[Uh[hI=jhI=UjhI=UmHnHu4F H v x z $IfgdI= $Ifgd[qkd $$Ifl5&& t0644 lap yty Vtiii^ $Ifgdy $Ifgd[kdk$$Ifl05&  t0644 lapyty6tiii` $IfgdI= $Ifgd[kd$$Ifl05&  t0644 lapyty68thh $$Ifa$gd[kd$$Ifl05&  t0644 lapyty  *,HJLjl,02FHJTVX|󰬨|g(jhhjRCJ(UaJ(mHnHu#jhhjRCJ(UaJ(hhjRCJ(aJ(jhhjRCJ(UaJ(hhNhI=jhxMUjhxMUjhxMUjhxMUj,hxMUjhxMUhxMh[hxMCJ'0X:trgYNN $Ifgd$$Ifa$gd-u $IfgdjRkdp$$Ifl0 5&  t0644 lapytxM|~: : :::::2:4:H:J:L:V:X:Z:\:b:::::::::::2;4;H;ʵ§~zo~jhjRUh-ujhjRUmHnHujhjRUhjRjhjRUhNjhUmHnHujhUUjhUh jhhUmHnHujhhU hhjhhU'TEXT      Symptoms:  FORMTEXT      If subject to seizures:What does the seizure look like? FORMTEXT      Is there any warning signs? FORMTEXT      How long does the seizure usually last? FORMTEXT      Is there a pattern to the seizures? FORMTEXT      How long does the child take to recover? FORMTEXT      Is there a known trigger? FORMTEXT      Managment issues: eg special precautions needed, indications for swimming, when to notify parents. FORMTEXT      Management of Condition:  FORMTEXT      Emergency medication prescribed  FORMCHECKBOX  Yes,  FORMCHECKBOX  No If Yes  what medication & how will this be administered?  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