Name
Month
Year
DAYS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Severe
Not able to work
Very impaired
Very impaired
Moderate
Able to work
Mild
No significant
impairment
NORMAL
Mild
No significant
impairment
Moderate
Able to work
Severe
Not able to work
Very impaired
Very impaired
Anxiety
0=None
1=Mild
Irritability
2=Moderate
3=Severe
Weight on day 1
Weight on day 28
Weight on day 28
Hours slept
Medication (name/mg)
