Epilepsy Care Plans

Epilepsy Welcome Care Plan Template

Key Objectives

Provide patients with information about their team.

Outcome measures

Equip patients and their families with the epilespy to track their health and share information with those around them.

Current Baselines

Patients don't currently have a space to keep their epilepsy information in one place or the ability to share it with the people they need to.

Example HTML code of Welcome and Getting Started Care Plan

a {word-wrap: break-word;}

.form-group {width: 100%; !important}

.cp_label {font-size: 18px;font-weight: 900;}

.cp_whiteBox {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; border-radius: 10px; border: 3px solid #014151;}

</style>

<h2>Welcome and getting started with Epilepsy!</h2>

<p>This platform is designed to support Children and Young People and their families with epilepsy to track health, share information with those you trust and keep your health information in one place. </p>

</div>

<h2>To get you started you can find</h2>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://s3.eu-central-1.amazonaws.com/pkb-uploads-nocrypto-eu-prod/456a253270d24989b2310fe2532c0f1c_seizure-first-aid-young-epilepsy.pdf">First aid information</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://s3.eu-central-1.amazonaws.com/pkb-uploads-nocrypto-eu-prod/559744c1ae33485aa530ee3121257980_SUDEP+Action+generic+risk+and+participation+leaflet.pdf">Participation and risk information including water safety</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://s3.eu-central-1.amazonaws.com/pkb-uploads-nocrypto-eu-prod/435c7f016f1d45a889428ffc485b1db6_Contact+Details+for+children+and+families+with+seizure+Dunkley+for+PKB.pdf">Contact details for your Epilepsy Team </a></li>

</ul>

<p><b>You can use this platform to</b></p>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/test/myMeasurements.action?contextUserId=">Record your seizures in a diary</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/test/mySymptoms.action?contextUserId=">Record other specific symptoms in a diary</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/diary/viewDiary.action?contextUserId=">Keep a general health journal</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/auth/composeMessageForm.action?">Send your Epilepsy Team a message, video or other attachment</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/auth/getInbox.action?">Send your Epilepsy Team a seizure description</a> - by selecting <b>'Start consultation'</b> on the Events and messages

section.</li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/library/manageLibrary.action?contextUserId=">Look at or add to your health library of epilepsy information</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/auth/listPlans.action">Look at or edit your health plans</a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://sandbox.patientsknowbest.com/patient/myDependents.action">Share this record with another trusted person</a></li>

</ul>

</div>

<h3>Colin Dunkley - Consultant Paediatrician</h3>

</div>

<h3>Kirsten Johnson - Roald Dahl Sapphire Children's Epilepsy Specialist Nurse</h3>

</div>

<h3>Paula Thurman - Patient Pathway Coordinator</h3>

</div>

Epilepsy Seizure Diary Care Plan Template

Key Objectives

Provide patients and their families with a digital care plan to record a child's seizures.

Outcome measures

Equip patients and their families with a place to record a child's seizure that can be shared digitally with their team.

Current Baselines

Patients and families are writing seizure diaries on paper and shared at the next appointment rather than in real time.

Example HTML code for Epilepsy Seizure Diary Care Plan

a {word-wrap: break-word;}

.form-group {width: 100%; !important}

.cp_label {font-size: 18px;font-weight: 900;}

ul {list-style:inherit; margin-left: 15px;}

.cp_whiteBox {border:2px solid #3C7996; background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px;}

</style>

<h3>Use this plan to document your child’s seizure types.</h3>

<p>The Monitoring Symptoms and Measurements sections above, lets you and your clinical team follow the number of seizures of each type, rescue medications given, and the types of common seizure triggers.</p>

<p>In the below boxes, describe each different type of seizure your child normally has.</p>

<p>See the <a href="#cp_SeizureDiary">Seizure Diary section</a> for instructions on how to record details of individual seizures, <b>if the seizure is different to the normal seizure types described below.</b></p>

<br />

<h3>Seizure Type 1</h3>

<label class="cp_label" for="cp_Sz1Patient">Patient Description - Please describe, do not use medical terms</label>

</div>

<h4>Professional Diagnosis of Epileptic Seizure Type 1 (For the healthcare professional to complete)</h4>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnset" id="cp_ProfDx1FocalOnset" value="FocalOnset">Focal onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnseta" id="cp_ProfDx1FocalOnseta" value="Impaired awareness">Impaired awareness</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetb" id="cp_ProfDx1FocalOnsetb" value="Atonic">Atonic</input>

</div>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetd" id="cp_ProfDx1FocalOnsetd" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsete" id="cp_ProfDx1FocalOnsete" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetf" id="cp_ProfDx1FocalOnsetf" value="Autonomic">Autonomic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetg" id="cp_ProfDx1FocalOnsetg" value="Cognitive">Cognitive</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnseth" id="cp_ProfDx1FocalOnseth" value="Sensory">Sensory</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnseti" id="cp_ProfDx1FocalOnseti" value="Temporal">Temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetj" id="cp_ProfDx1FocalOnsetj" value="Parietal">Parietal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetk" id="cp_ProfDx1FocalOnsetk" value="Gelastic">Gelastic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetl" id="cp_ProfDx1FocalOnsetl" value="Automatisms">Automatisms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetm" id="cp_ProfDx1FocalOnsetm" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetn" id="cp_ProfDx1FocalOnsetn" value="Right">Right</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnseto" id="cp_ProfDx1FocalOnseto" value="Hyperkinetic">Hyperkinetic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetp" id="cp_ProfDx1FocalOnsetp" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetq" id="cp_ProfDx1FocalOnsetq" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetr" id="cp_ProfDx1FocalOnsetr" value="Emotional">Emotional</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsets" id="cp_ProfDx1FocalOnsets" value="Centro-temporal">Centro-temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsett" id="cp_ProfDx1FocalOnsett" value="Frontal">Frontal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetu" id="cp_ProfDx1FocalOnsetu" value="Occipital">Occipital</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetv" id="cp_ProfDx1FocalOnsetv" value="Focal to bilateral tonic clonic">Focal to bilateral tonic clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1FocalOnsetw" id="cp_ProfDx1FocalOnsetw" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnset" id="cp_ProfDx1GenOnset" value="GenOnset">Generalised onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnseta" id="cp_ProfDx1GenOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetb" id="cp_ProfDx1GenOnsetb" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetc" id="cp_ProfDx1GenOnsetc" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetd" id="cp_ProfDx1GenOnsetd" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsete" id="cp_ProfDx1GenOnsete" value="Myoclonic-tonic-clonic">Myoclonic-tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetf" id="cp_ProfDx1GenOnsetf" value="Myoclonic-atonic">Myoclonic-atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetg" id="cp_ProfDx1GenOnsetg" value="Atonic">Atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnseth" id="cp_ProfDx1GenOnseth" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnseti" id="cp_ProfDx1GenOnseti" value="Typical absence">Typical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetj" id="cp_ProfDx1GenOnsetj" value="Atypical absence">Atypical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetk" id="cp_ProfDx1GenOnsetk" value="Myoclonic absence">Myoclonic absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetl" id="cp_ProfDx1GenOnsetl" value="Absence with eyelid myoclonia">Absence with eyelid myoclonia</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1GenOnsetm" id="cp_ProfDx1GenOnsetm" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1UnknownOnset" id="cp_ProfDx1UnknownOnset" value="UnknownOnset">Unknown onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1UnknownOnseta" id="cp_ProfDx1UnknownOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1UnknownOnsetb" id="cp_ProfDx1UnknownOnsetb" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1UnknownOnsetc" id="cp_ProfDx1UnknownOnsetc" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx1UnknownOnsetd" id="cp_ProfDx1UnknownOnsetd" value="Other">Other</input>

</div>

<label class="cp_Sz1Other" for="cp_Sz1Other">If other, please state:</label>

</div>

<h3>Seizure Type 2</h3>

<label class="cp_Sz2" for="cp_Sz2Patient">Patient Description - Please describe, do not use medical terms</label>

</div>

<h4>Professional Diagnosis of Epileptic Seizure Type 2 (For the healthcare professional to complete)</h4>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnset" id="cp_ProfDx2FocalOnset" value="FocalOnset">Focal onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnseta" id="cp_ProfDx2FocalOnseta" value="Impaired awareness">Impaired awareness</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetb" id="cp_ProfDx2FocalOnsetb" value="Atonic">Atonic</input>

</div>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetd" id="cp_ProfDx2FocalOnsetd" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsete" id="cp_ProfDx2FocalOnsete" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetf" id="cp_ProfDx2FocalOnsetf" value="Autonomic">Autonomic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetg" id="cp_ProfDx2FocalOnsetg" value="Cognitive">Cognitive</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnseth" id="cp_ProfDx2FocalOnseth" value="Sensory">Sensory</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnseti" id="cp_ProfDx2FocalOnseti" value="Temporal">Temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetj" id="cp_ProfDx2FocalOnsetj" value="Parietal">Parietal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetk" id="cp_ProfDx2FocalOnsetk" value="Gelastic">Gelastic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetl" id="cp_ProfDx2FocalOnsetl" value="Automatisms">Automatisms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetm" id="cp_ProfDx2FocalOnsetm" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetn" id="cp_ProfDx2FocalOnsetn" value="Right">Right</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnseto" id="cp_ProfDx2FocalOnseto" value="Hyperkinetic">Hyperkinetic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetp" id="cp_ProfDx2FocalOnsetp" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetq" id="cp_ProfDx2FocalOnsetq" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetr" id="cp_ProfDx2FocalOnsetr" value="Emotional">Emotional</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsets" id="cp_ProfDx2FocalOnsets" value="Centro-temporal">Centro-temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsett" id="cp_ProfDx2FocalOnsett" value="Frontal">Frontal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetu" id="cp_ProfDx2FocalOnsetu" value="Occipital">Occipital</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetv" id="cp_ProfDx2FocalOnsetv" value="Focal to bilateral tonic clonic">Focal to bilateral tonic clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2FocalOnsetw" id="cp_ProfDx2FocalOnsetw" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnset" id="cp_ProfDx2GenOnset" value="GenOnset">Generalised onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnseta" id="cp_ProfDx2GenOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetb" id="cp_ProfDx2GenOnsetb" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetc" id="cp_ProfDx2GenOnsetc" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetd" id="cp_ProfDx2GenOnsetd" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsete" id="cp_ProfDx2GenOnsete" value="Myoclonic-tonic-clonic">Myoclonic-tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetf" id="cp_ProfDx2GenOnsetf" value="Myoclonic-atonic">Myoclonic-atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetg" id="cp_ProfDx2GenOnsetg" value="Atonic">Atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnseth" id="cp_ProfDx2GenOnseth" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnseti" id="cp_ProfDx2GenOnseti" value="Typical absence">Typical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetj" id="cp_ProfDx2GenOnsetj" value="Atypical absence">Atypical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetk" id="cp_ProfDx2GenOnsetk" value="Myoclonic absence">Myoclonic absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetl" id="cp_ProfDx2GenOnsetl" value="Absence with eyelid myoclonia">Absence with eyelid myoclonia</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2GenOnsetm" id="cp_ProfDx2GenOnsetm" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2UnknownOnset" id="cp_ProfDx2UnknownOnset" value="UnknownOnset">Unknown onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2UnknownOnseta" id="cp_ProfDx2UnknownOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2UnknownOnsetb" id="cp_ProfDx2UnknownOnsetb" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2UnknownOnsetc" id="cp_ProfDx2UnknownOnsetc" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx2UnknownOnsetd" id="cp_ProfDx2UnknownOnsetd" value="Other">Other</input>

</div>

<label class="cp_Sz2Other" for="cp_Sz2Other">If other, please state:</label>

</div>

<h3>Seizure Type 3</h3>

<label class="cp_Sz3Patient" for="cp_Sz3Patient">Patient Description - Please describe, do not use medical terms</label>

</div>

<h4>Professional Diagnosis of Epileptic Seizure Type 3 (For the healthcare professional to complete)</h4>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnset" id="cp_ProfDx3FocalOnset" value="FocalOnset">Focal onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnseta" id="cp_ProfDx3FocalOnseta" value="Impaired awareness">Impaired awareness</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetb" id="cp_ProfDx3FocalOnsetb" value="Atonic">Atonic</input>

</div>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetd" id="cp_ProfDx3FocalOnsetd" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsete" id="cp_ProfDx3FocalOnsete" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetf" id="cp_ProfDx3FocalOnsetf" value="Autonomic">Autonomic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetg" id="cp_ProfDx3FocalOnsetg" value="Cognitive">Cognitive</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnseth" id="cp_ProfDx3FocalOnseth" value="Sensory">Sensory</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnseti" id="cp_ProfDx3FocalOnseti" value="Temporal">Temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetj" id="cp_ProfDx3FocalOnsetj" value="Parietal">Parietal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetk" id="cp_ProfDx3FocalOnsetk" value="Gelastic">Gelastic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetl" id="cp_ProfDx3FocalOnsetl" value="Automatisms">Automatisms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetm" id="cp_ProfDx3FocalOnsetm" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetn" id="cp_ProfDx3FocalOnsetn" value="Right">Right</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnseto" id="cp_ProfDx3FocalOnseto" value="Hyperkinetic">Hyperkinetic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetp" id="cp_ProfDx3FocalOnsetp" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetq" id="cp_ProfDx3FocalOnsetq" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetr" id="cp_ProfDx3FocalOnsetr" value="Emotional">Emotional</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsets" id="cp_ProfDx3FocalOnsets" value="Centro-temporal">Centro-temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsett" id="cp_ProfDx3FocalOnsett" value="Frontal">Frontal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetu" id="cp_ProfDx3FocalOnsetu" value="Occipital">Occipital</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetv" id="cp_ProfDx3FocalOnsetv" value="Focal to bilateral tonic clonic">Focal to bilateral tonic clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3FocalOnsetw" id="cp_ProfDx3FocalOnsetw" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnset" id="cp_ProfDx3GenOnset" value="GenOnset">Generalised onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnseta" id="cp_ProfDx3GenOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetb" id="cp_ProfDx3GenOnsetb" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetc" id="cp_ProfDx3GenOnsetc" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetd" id="cp_ProfDx3GenOnsetd" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsete" id="cp_ProfDx3GenOnsete" value="Myoclonic-tonic-clonic">Myoclonic-tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetf" id="cp_ProfDx3GenOnsetf" value="Myoclonic-atonic">Myoclonic-atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetg" id="cp_ProfDx3GenOnsetg" value="Atonic">Atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnseth" id="cp_ProfDx3GenOnseth" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnseti" id="cp_ProfDx3GenOnseti" value="Typical absence">Typical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetj" id="cp_ProfDx3GenOnsetj" value="Atypical absence">Atypical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetk" id="cp_ProfDx3GenOnsetk" value="Myoclonic absence">Myoclonic absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetl" id="cp_ProfDx3GenOnsetl" value="Absence with eyelid myoclonia">Absence with eyelid myoclonia</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3GenOnsetm" id="cp_ProfDx3GenOnsetm" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3UnknownOnset" id="cp_ProfDx3UnknownOnset" value="UnknownOnset">Unknown onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3UnknownOnseta" id="cp_ProfDx3UnknownOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3UnknownOnsetb" id="cp_ProfDx3UnknownOnsetb" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3UnknownOnsetc" id="cp_ProfDx3UnknownOnsetc" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx3UnknownOnsetd" id="cp_ProfDx3UnknownOnsetd" value="Other">Other</input>

</div>

<label class="cp_Sz3Other" for="cp_Sz3Other">If other, please state:</label>

</div>

<h3>Seizure Type 4</h3>

<label class="cp_Sz4Patient" for="cp_Sz4Patient">Patient Description - Please describe, do not use medical terms</label>

</div>

<h4>Professional Diagnosis of Epileptic Seizure Type 4 (For the healthcare professional to complete)</h4>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnset" id="cp_ProfDx4FocalOnset" value="FocalOnset">Focal onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnseta" id="cp_ProfDx4FocalOnseta" value="Impaired awareness">Impaired awareness</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetb" id="cp_ProfDx4FocalOnsetb" value="Atonic">Atonic</input>

</div>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetd" id="cp_ProfDx4FocalOnsetd" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsete" id="cp_ProfDx4FocalOnsete" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetf" id="cp_ProfDx4FocalOnsetf" value="Autonomic">Autonomic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetg" id="cp_ProfDx4FocalOnsetg" value="Cognitive">Cognitive</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnseth" id="cp_ProfDx4FocalOnseth" value="Sensory">Sensory</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnseti" id="cp_ProfDx4FocalOnseti" value="Temporal">Temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetj" id="cp_ProfDx4FocalOnsetj" value="Parietal">Parietal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetk" id="cp_ProfDx4FocalOnsetk" value="Gelastic">Gelastic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetl" id="cp_ProfDx4FocalOnsetl" value="Automatisms">Automatisms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetm" id="cp_ProfDx4FocalOnsetm" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetn" id="cp_ProfDx4FocalOnsetn" value="Right">Right</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnseto" id="cp_ProfDx4FocalOnseto" value="Hyperkinetic">Hyperkinetic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetp" id="cp_ProfDx4FocalOnsetp" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetq" id="cp_ProfDx4FocalOnsetq" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetr" id="cp_ProfDx4FocalOnsetr" value="Emotional">Emotional</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsets" id="cp_ProfDx4FocalOnsets" value="Centro-temporal">Centro-temporal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsett" id="cp_ProfDx4FocalOnsett" value="Frontal">Frontal</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetu" id="cp_ProfDx4FocalOnsetu" value="Occipital">Occipital</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetv" id="cp_ProfDx4FocalOnsetv" value="Focal to bilateral tonic clonic">Focal to bilateral tonic clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4FocalOnsetw" id="cp_ProfDx4FocalOnsetw" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnset" id="cp_ProfDx4GenOnset" value="GenOnset">Generalised onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnseta" id="cp_ProfDx4GenOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetb" id="cp_ProfDx4GenOnsetb" value="Clonic">Clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetc" id="cp_ProfDx4GenOnsetc" value="Tonic">Tonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetd" id="cp_ProfDx4GenOnsetd" value="Myoclonic">Myoclonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsete" id="cp_ProfDx4GenOnsete" value="Myoclonic-tonic-clonic">Myoclonic-tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetf" id="cp_ProfDx4GenOnsetf" value="Myoclonic-atonic">Myoclonic-atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetg" id="cp_ProfDx4GenOnsetg" value="Atonic">Atonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnseth" id="cp_ProfDx4GenOnseth" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnseti" id="cp_ProfDx4GenOnseti" value="Typical absence">Typical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetj" id="cp_ProfDx4GenOnsetj" value="Atypical absence">Atypical absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetk" id="cp_ProfDx4GenOnsetk" value="Myoclonic absence">Myoclonic absence</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetl" id="cp_ProfDx4GenOnsetl" value="Absence with eyelid myoclonia">Absence with eyelid myoclonia</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4GenOnsetm" id="cp_ProfDx4GenOnsetm" value="Other">Other</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4UnknownOnset" id="cp_ProfDx4UnknownOnset" value="UnknownOnset">Unknown onset</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4UnknownOnseta" id="cp_ProfDx4UnknownOnseta" value="Tonic-clonic">Tonic-clonic</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4UnknownOnsetb" id="cp_ProfDx4UnknownOnsetb" value="Epileptic spasms">Epileptic spasms</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4UnknownOnsetc" id="cp_ProfDx4UnknownOnsetc" value="Behaviour arrest">Behaviour arrest</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_ProfDx4UnknownOnsetd" id="cp_ProfDx4UnknownOnsetd" value="Other">Other</input>

</div>

<label class="cp_Sz4Other" for="cp_Sz4Other">If other, please state:</label>

</div>

<br />

</div>

<h3>Seizure Diary</h3>

<p>To keep a seizure diary of individual seizures, use the <a href="/diary/viewDiary.action" target="_blank">journal</a> section to document the details. You can add new entires or edit old entries. You can also discuss an entry, sending a message to your team. See <a href="https://manual.patientsknowbest.com/patient/journal" target="_blank">the manual</a> for help.</p>

<p>The following is a guide of what to include in your entries, <b>if the seizure is different to the normal seizure types described above.</b></p>

<p><b>If the seizure is similar to the types you described above,</b> please use the Symptoms and Measurements at the top to note anything present before the seizure happened and what type of seizure it was.</p>

<br />

<p><b>Seizure triggers:</b></p>

<ul>

<li style="list-style:inherit; margin-left: 15px;">medication changes — has the dose changed / have you missed a dose / any supply issues / change of medication brand</li>

<li style="list-style:inherit; margin-left: 15px;">sleep changes</li>

<li style="list-style:inherit; margin-left: 15px;">diet changes</li>

<li style="list-style:inherit; margin-left: 15px;">emotional stress</li>

<li style="list-style:inherit; margin-left: 15px;">fever or overheated</li>

<li style="list-style:inherit; margin-left: 15px;">hormonal fluctuations</li>

<li style="list-style:inherit; margin-left: 15px;">constipation</li>

<li style="list-style:inherit; margin-left: 15px;">weight gain</li>

<li style="list-style:inherit; margin-left: 15px;">sensory — eg sudden noise or pain</li>

<li style="list-style:inherit; margin-left: 15px;">bright or flashing light exposure — have you been told your child is photosensitive?</li>

<li style="list-style:inherit; margin-left: 15px;">alcohol</li>

<li style="list-style:inherit; margin-left: 15px;">anything else</li>

</ul>

<br />

<p><b>Description of the seizure:</b></p>

<ul>

<li style="list-style:inherit; margin-left: 15px;">any warning signs — eg behaviour, frightened, tingling sensation</li>

<li style="list-style:inherit; margin-left: 15px;">loss of urine or bowel control</li>

<li style="list-style:inherit; margin-left: 15px;">changes in awareness</li>

<li style="list-style:inherit; margin-left: 15px;">loss of ability to communicate</li>

<li style="list-style:inherit; margin-left: 15px;">repetitive movements</li>

<li style="list-style:inherit; margin-left: 15px;">muscle stiffness</li>

<li style="list-style:inherit; margin-left: 15px;">muscle jerking</li>

<li style="list-style:inherit; margin-left: 15px;">eye changes — eg open / close / pupils dilated</li>

<li style="list-style:inherit; margin-left: 15px;">colour — pale / blue round the lips and nose / flushed / yellow</li>

<li style="list-style:inherit; margin-left: 15px;">any changes in breathing?</li>

<li style="list-style:inherit; margin-left: 15px;">any noises — eg grunting / gurgling</li>

<li style="list-style:inherit; margin-left: 15px;">vomiting</li>

<li style="list-style:inherit; margin-left: 15px;">any injuries</li>

<li style="list-style:inherit; margin-left: 15px;">anything else</li>

</ul>

<br />

<p><b>What happened after the seizure:</b></p>

<ul>

<li style="list-style:inherit; margin-left: 15px;">unable to communicate</li>

<li style="list-style:inherit; margin-left: 15px;">can they remember the seizure they just had</li>

<li style="list-style:inherit; margin-left: 15px;">muscle weakness</li>

<li style="list-style:inherit; margin-left: 15px;">are they sleepy</li>

<li style="list-style:inherit; margin-left: 15px;">how long before they return to normal</li>

<li style="list-style:inherit; margin-left: 15px;">anything else — eg headache</li>

</ul>

<p><b>You can Copy and Paste the below into your <a href="/diary/viewDiary.action" target="_blank">journal</a> entry as a guide to describe each seizure, if it is different to the normal seizure types described above:</b></p>

<p>Seizure duration:</p>

<p>Seizure triggers:</p>

<p>Description of the seizure:</p>

<p>What happened after the seizure:</p>

</div>

Ready Steady Go Care Plan Template

Key Objectives

Provide patients with a digital care plan at the beginning of their transition from child to adult care.

Outcome measures

Equip patients with the information and support they need to manage the transition from the peadiatric team to their adult care team.

Current Baselines

All care plans and processes are paper based.

Examples HTML for Ready Steady Go Care Plan

a {word-wrap: break-word;}

.form-group {width: 100%; !important}

.cp_label {font-size: 18px;font-weight: 900;}

.cp_whiteBox {margin-bottom: 15px; padding: 20px; border: 3px solid #0c475e; background-color: #ffffff; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

h2 {color: #00A8D7;}

.red {color: #ff0000}

.amber {color: #ff6600;}

.green {color: #009933;}

</style>

<li style="list-style:inherit; margin-left: 15px;"><a href="#1"><b>Knowledge and skills</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#2"><b>Self advocacy</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#3"><b>Health and lifestyle</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#4"><b>Daily living</b></a></li>

<li style="list-style:inherit; margin-left: 15px;"><a href="#5"><b>School/career/future</b></a></li>

</ul>

</div>

<h3 class="purpleText">Knowledge and skills</h3>

<label class="cp_label" for="cp_q1">What is the name of your children's doctor?</label>

</div>

</div>

<option value="--">Select</option>

<option style="color: #ff000" value="Ready">Ready</option>

<option style="color: #ff6600" value="Steady">Steady</option>

</select>

</div>

<label class="cp_label" for="cp_q2">Why do you need to know what type of epilepsy you have?</label>

</div>

</div>

<option value="--">Select</option>

<option value="Ready">Ready</option>

<option value="Steady">Steady</option>

</select>

</div>

<label class="cp_label" for="cp_q3">Do you understand the medical terms used in clinics?</label>

</div>

</div>

<option value="--">Select</option>

<option value="Ready">Ready</option>

<option value="Steady">Steady</option>

</select>

</div>

<label class="cp_label" for="cp_q4">Can you explain why you take the different medications you do?</label>

</div>

</div>

<option value="--">Select</option>

<option value="Ready">Ready</option>

<option value="Steady">Steady</option>

</select>

</div>

<label class="cp_label" for="cp_q1">Points discussed:</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q1_1" id="cp_q1_1" value="It is important that you are able to explain your type of seizures to others both friends and future employers."> It is important that you are able to explain your type of seizures to others both friends and future employers.</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q1_2" id="cp_q1_2" value=" Medications are chosen because of the type of epilepsy you have."> Medications are chosen because of the type of epilepsy you have.</input>

</div>

<label class="cp_label" for="cp_q1a">Comments:</label>

</div>

<label class="cp_label" for="cp_q5">Tell me what medication you are on for your epilepsy?</label>

</div>

</div>

<option value="--">Select</option>

<option value="Ready">Ready</option>

<option value="Steady">Steady</option>

</select>

</div>

<label class="cp_label" for="cp_q5a">Points discussed:</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q5_1" id="cp_q5_1" value="Side effects are often a concern if you start a new medicine. Often any side effects settle after a while and are not a long term problem. If there are ongoing concerns about side effects short term or long term it is important to share these with your epilepsy team."> Side effects are often a concern if you start a new medicine. Often any side effects settle after a while and are not a long term problem. If there are ongoing concerns about side effects short term or long term it is important to share these with your epilepsy team.</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q5_2" id="cp_q5_2" value=" If a rash develops when a medication starts or in the first few weeks it is important to have it checked as soon as possible."> If a rash develops when a medication starts or in the first few weeks it is important to have it checked as soon as possible.</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q5_3" id="cp_q5_3" value=" There can be subtle side effects with learning and behaviour."> There can be subtle side effects with learning and behaviour.</input>

</div>

<label class="cp_label" for="cp_q5a">Comments:</label>

</div>

<label class="cp_label" for="cp_q6">How do you remember to take your medicine each day?</label>

</div>

</div>

<option value="--">Select</option>

<option value="Ready">Ready</option>

<option value="Steady">Steady</option>

</select>

</div>

<label class="cp_label" for="cp_q7">How many doses do you miss?</label>

</div>

</div>

<option value="--">Select</option>

<option value="Ready">Ready</option>

<option value="Steady">Steady</option>

</select>

</div>

<label class="cp_label" for="cp_q7">Points discussed:</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q7_1" id="cp_q7_1" value="Young people have their own way of remembering to take medicine reliably-a regular routine is helpful as can an alarm set up on your mobile."> Young people have their own way of remembering to take medicine reliably - a regular routine is helpful as can an alarm set up on your mobile.</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q7_2" id="cp_q7_2" value=" You can get more information about vomiting/missed doses on the Medicines for Children website-the epilepsy medicines are listed there."> You can get more information about vomiting/missed doses on the Medicines for Children website - the epilepsy medicines are listed there.</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_q7_3" id="cp_q7_3" value=" Usually if a person vomits 20-30 minutes after having their dose it can be repeated."> Usually if a person vomits 20-30 minutes after having their dose it can be repeated.</input>

</div>

<label class="cp_label" for="cp_q7a">Comments:</label>

</div>