Day 1 Dosing Information
Enter the date and time you took your dose of investigational product the day after your Baseline Visit. Enter ND in Time column if a dose was missed. Dose: Refer to the Dosing Instructions on the Diary Instructions page for the time you should take your dose. This dose should be taken at the same time every day.
datetime
Day 2 Dosing Information
Enter the date and time you took your dose of investigational product the day after your Baseline Visit. Enter ND in Time column if a dose was missed. Dose: Refer to the Dosing Instructions on the Diary Instructions page for the time you should take your dose. This dose should be taken at the same time every day.
datetime
Day 3 Dosing Information
Enter the date and time you took your dose of investigational product the day after your Baseline Visit. Enter ND in Time column if a dose was missed. Dose: Refer to the Dosing Instructions on the Diary Instructions page for the time you should take your dose. This dose should be taken at the same time every day.
datetime
RLS Symptoms Diary - Last Week of Treatment Phase
From 7 a.m. on
date
to 6:59 a.m. on
date
What was the first time your RLS symptoms began between the times above:
time
Did you have RLS symptoms in this time frame?
If Yes, continue below
boolean
If Yes, continue below
boolean
If Yes, continue below
boolean
Estimate of total number of hours of symptoms during time frame 1 e.g., enter 1 hour and 30 minutes as 1.30
Cannot be greater than or equal to 10 hours.
float
Cannot be greater than or equal to 3 hours.
float
Cannot be greater than or equal to 11 hours.
float
Location of symptoms during this time frame - Check all that apply:
1. 7:00 a.m. to 4:59 p.m.
integer
2. 5:00 p.m. to 7:59 p.m.
integer
3. 8:00 p.m. to 6:59 a.m.
integer
Maximum severity of symptoms during this time frame - Check one:
1. 7:00 a.m. to 4:59 p.m.
integer
2. 5:00 p.m. to 7:59 p.m.
integer
3. 8:00 p.m. to 6:59 a.m.
integer