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Chapter 61848. Is the individual using medication? □ No□ Yes (please list all medication) _______________________________________________________________________________________________________________________________________9. (a) Does the individual have epilepsy, now or in the past? □ No (go to question 9)□ Yes(b) At what age did the first seizure occur? _____ years and _____ months□ I don’t know(c) How often do seizures occur?□ Daily, approximately _____ per day□ Weekly, approximately _____ per week□ Monthly, approximately _____ per month□ The individual is seizure free, since _____ years old(d) Does the individual have a vagal nerve stimulator?□ No□ Yes(e) Is the individual on a ketogenic diet?□ No□ Yes10. What is the (estimated) level of intellectual functioning of the individual?□ Normal intellectual ability□ Normal intellectual ability with specific learning disability (dyscalculia, dyslexia)□ Mild or moderate intellectual disability□ Severe or profound intellectual disability□ I don’t know11. What was the last measured IQ or developmental age of the individual?□ The IQ was _____ measured on __________ (date or year)□ The developmental age was (approximately) _____ measured on __________ (date or year)□ I don’t know12. What is the highest level of education the individual completed?□ None □ Preschool/kindergarten □ Primary education □ Primary education, special education program□ Lower secondary education (Middle school or Junior High) □ Secondary education, special education program□ Upper to post-secondary (Senior High school, 1-year certificate programs) □ Academic higher education or doctoral (Bachelor, Master, PhD)□ I don’t knowAnnelieke Muller sHL.indd 184 14-11-2023 09:07