Subject Bedtime Diary
Fill in itemgroup for seven days.
integer
Diary Entry Date
date
The "DE:GER (Germany/German)" version of this form uses 24hr format.
time
The "DE:GER (Germany/German)" version of this form uses 24hr format, and this item is not included in that form.
text
Bedtimes ranked chronologically
Bedtime No.
text
Bedtime
time
Median Habitual Bedtime
Median of odd number of bedtimes is the bedtime (non-rounded) with equal number of earlier and later times after ranking chronologically; median of even number of bedtimes is mean of 2 middle times after ranking.
time
Call the subject back to schedule the date and time of their arrival at the clinic for their first PSG screening visit. Note: Subjects are to arrive at the clinic in the evening no less than 2 hours before receiving study medication, which is taken 60 minutes before the Median Habitual Bedtime (determined from the Subject Bedtime Diary calculations).
time
Print Name
text
Signature of Investigator calculating Median Habitual Bedtime
text
Date of Median Habitual Bedtime Calculation
date