TO WHOM SO EVER IT MAY CONCERN

This is to certify that my Patient W/on eeds 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 :