Premium Essay

Hatred in America

In: English and Literature

Submitted By thomastpa2
Words 1329
Pages 6
The Bipolar II Disorder Workbook

Daily Diary Card

DAILY DIARY CARD
Date:
FEMALES ONLY: Did you have menstrual flow today?
• What was the first day of your last period?
Last night’s SLEEP
• Time you went to bed last night:
• Time you woke up this morning:

Any naps today?

Did you sleep through the night?

Did you have energy that sustained you throughout the day?

ADDITIONAL NOTES ON SLEEP

MEDICATIONS TAKEN TODAY
1.
2.
3.
4.
5.
6.
7.
8.
© 2014 Stephanie McMurrich Roberts, Louisa Sylvia, and Noreen Reilly-Harrington / New Harbinger Publications.
Permission is granted to the reader to reproduce this form for personal use.

The Bipolar II Disorder Workbook

Daily Diary Card

ADDITIONAL NOTES ON MEDICATIONS

MOOD TRACKING (CHECK ONE) +3 SEVERELY ELEVATED (Significant Impairment; Not Able to Work) +2 MODERATELY ELEVATED (Significant Impairment; Able to Work) +1 MILDLY ELEVATED (No Significant Impairment; Able to Work) ±0 BASELINE (“Normal”/Grounded/Capable & Able/Productive) –­ MILDLY DEPRESSED (No Significant Impairment)
1
–­ MODERATELY DEPRESSED (Significant Impairment; Able to Work)
2
–­ SEVERELY DEPRESSED (Significant Impairment; Not Able to Work)
3
Any thoughts of suicide today?
Anxiety Rating*:

COMMENTS:

Irritability Rating*:

COMMENTS:

* Rating: 0 = NONE, 1 = MILD, 2 = MODERATE, 3 = SEVERE

© 2014 Stephanie McMurrich Roberts, Louisa Sylvia, and Noreen Reilly-Harrington / New Harbinger Publications.
Permission is granted to the reader to reproduce this form for personal use.

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