TO WHOM SO EVER IT MAY CONCERN

This is to certify that my Patient ________________________, W/o.

____________________________needs medical assistance to be accompanied by
husband at all times for look after Nocturnal Seizure, regular follow up &
Treatment.
PATIENT HISTORY:
__________________________________________________
Married / Unmarried
Occupation: _______________________

DIAGNOSIS:
Known case of Epilepsy since 12 years of age
Generalised Tonic Clonic Seizures – Nocturnal
Total Episodes – 6
Last Attack Dt: _____________ , Time: ________________
Drug Compliance is Good

TREATMENT:
1. Tab. Levara XR
2. Tab. Naxdan
3. Midacep Nasal Spray S Puff in Each Nostril
4. Patient Needs Husband for look after nocturnal seizure and regular
follow up and treatment

Please contact me if any additional information is required.

Place :
Date :