Form Id: SCR_EPILEPSY
ENGLISH FRANÇAIS PORTUGUÊS ITALIANOEpilepsy Screening (positive if only one of the following 5 answers is positive) | |
| 1. Have you ever lost consciousness, then fallen and at the same time foamed at the mouth (excessive salivation) and/or defecated or urinated on yourself?: | |
| 2. Have you ever been told that you suddenly stop talking, eating or working for a short period of time (seconds) and don't respond when someone calls you? And after that episode, do you continue with the activity you were carrying out?: | |
| 3. Have you ever had uncontrolled movements (convulsions) of one or more limbs (arms, legs, head) or had an illness attack that started suddenly and lasted only a short time, a few minutes?: | |
| 4. While you are awake do you hear sounds and/or voices, see things, people, animals or other things, or smell smells that are not there for a short period of time, a few seconds?: | |
| 5. Have you ever been told that you have epilepsy or have had epileptic seizures or manifested spirits or suffer from evil spirits?: | |
| Screening Score: | RESULT: SCORE |
| Screening Result: (automatic evaluation not working in preview) | |
Note: This is just a preview: not all features are guaranteed
