| RPT |
.| .| Smith Morningness/Eveningness Questionnaire| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>|
<*Answer_6681*>| 9. One hears about "morning" and "evening" type people. Which ONE of these types do you consider yourself to be?| <*Answer_6682*>| 10. When would you prefer to rise (provided
you have a full day's work - 8 hours) if you were totally free to arrange your time?| <*Answer_6683*>| 11. If you always had to rise at 6:00 am, what do you think it would be like?|
<*Answer_6684*>| 12. How long a time does it usually take before you "recover your senses" in the morning after rising from a night's sleep?| <*Answer_6685*>| 13. Please indicate to what extent
you are a morning or an evening active individual?| <*Answer_6686*>| | | Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic
purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.| $~
DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | Scoring:| | 22 and less - evening type| 23 - 43 - intermediate type| 44 and
above - morning type| | | CSM Score: <-CSM->| | | Questions and Answers| | 1. Considering only your own "feeling best" rhythm, at what time would you get up if you were entirely
free to plan your day?| <*Answer_6674*>| 2. Considering only your own "feeling best" rhythm, at what time would you go to bed if you were entirely free to plan your evening?|
<*Answer_6675*>| 3. Assuming normal circumstances, how easy do you find getting up in the morning?| <*Answer_6676*>| 4. How alert do you feel after the first half hour after having awakened in
the morning?| <*Answer_6677*>| 5. During the first half hour after having awakened in the morning, how tired do you feel?| <*Answer_6678*>| 6. You have decided to engage in some physical
exercise. A friend suggests that you do this one hour twice a week and the best time for him is 7:00-8:00 am. Bearing in mind nothing else but your "feeling best" rhythm, how do you think you
would perform? | <*Answer_6679*>| 7. At what time in the evening do you feel tired and as a result, in need of sleep?| <*Answer_6680*>| 8. You wish to be at your peak performance for a two
hour test, which will be mentally exhausting. You are entirely free to plan your day, and considering only your own "feeling best" rhythm, which ONE of the four testing times would you choose? |
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