No. | Ground | Yes | No |
1. | Are you physically and mentally ready to participate in this research? |
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2. | Have you slept last 24 hours?
If your answer is “yes”, then mention the duration: ............................. hours/minute |
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3. | Is it your habit to sleep less?
If your answer is “yes”, then how many hours do you sleep daily? ................. hours |
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4. | Do you suffer from insomnia? |
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5. | Are you suffering from any types of brain injury? If yes, when ..............................................? |
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6. | Are you suffering from Alzheimers, Dementia or any other mental disease? If so, then mention ................................................................ |
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7. | Are you suffering from any disease or physical illness right now? If so, then mention those: .............................................................. |
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8. | Are you taking any medicine for any reason? If so, then mention those: ........................................................... |
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9. | Did you ever get a hit at your brain in the past? If so, then when?..................... Did you get admitted to a hospital? .......................... |
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10. | Did you suffer from any deadly disease in the past? If so, then when?..................... Did you get admitted to a hospital? ........................................ |
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11. | Have you taken coffee, energy drink, alcohol or smoked in last 24 hours? |
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12. | Have you taken any chocolates/lozenge/toffee in last 24 hours? |
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13. | Have you recorded your daily activities in the Sleep Log that you were given? |
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