Movement Disorders Emergency Action Plan

Personal Information

• Patient Name: _________________
• Date of Birth: ________________
• Primary Diagnosis: ____________

Emergency Contacts

1. Neurologist: _________________ Phone: _________________
2. Primary Care: ________________ Phone: _________________
3. Emergency Contact: ___________ Phone: _________________

Warning Signs Requiring Immediate Action

Severe Symptoms (Call 911)

• Loss of consciousness
• Difficulty breathing
• Severe falls with injury
• Prolonged seizure activity (>5 minutes)
• Chest pain

Urgent Symptoms (Contact Neurologist)

• Sudden increase in tremors
• Significant medication side effects
• Severe muscle rigidity
• New or worsening balance problems
• Sudden changes in movement control

Medication Information

• Current medications and dosages: _________________
• Known allergies: _________________
• Recent medication changes: _________________

Action Steps During Emergency

1. Stay calm and ensure patient safety
2. Note time symptoms began
3. Document any triggers or preceding events
4. Have medication list ready
5. Follow specific instructions below based on symptoms

Special Instructions

• For dystonic crisis: _________________
• For freezing episodes: _________________
• For medication reactions: _________________

Hospital Preferences

• Preferred hospital: _________________
• Nearest emergency department: _________________

Important Notes

• Keep this plan updated and easily accessible
• Bring to all medical appointments
• Share with family members and caregivers
• Review and update every 6 months