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Has today been an unusual day in any respect?
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Has today been an unusual day in any respect? Free Text
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How much sleep did you get last night
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Did you take a nap today?
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If you took a nap, how long was it?
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Did you have any of the following today, please select all
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If you took any of the drinks above, please indicate amount and time
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Please list any medications you will be taking tonight with their dose and time
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Do you have any physical complaints right now
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If you have a physical complaint please explain
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Check one statement that best describes how you feel right now
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What time do you normally go to sleep
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Please indicate your desired bedtime tonight
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