Since your last visit, have your seizures improved, worsened, or stayed about the same? Improved Worsened Same No seizures Since your last visit, what was the highest number of seizures you had in one day? 1 2 3 4 5 >5 Since your last visit, have you been injured because of a seizure? Y N Since your last visit, have you gone to an emergency room or been admitted to a hospital? Y N If you have, was it because of a seizure? Y N Are you taking a brand name medication, a generic version, or both? Generic Both Brand What medications? During the past week, have you taken your medication exactly as directed? Yes Unsure No If not, how often have you taken it and why? Do you have any help at home with your medication? Y N Are you experiencing any side effects from your seizure medication? Y N What side effects? Do you have a valid driver's license? Y N Do you currently drive? Y N