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8 – TEDAVİYİ DEĞERLENDİRME ÇİZELGESİ<br />
Günler 1 2 3 4 5 6<br />
İlaçlar<br />
Aldım ( ) ( ) ( ) ( ) ( ) ( )<br />
Uyku<br />
Normal ( ) ( ) ( ) ( ) ( ) ( )<br />
Yetersiz ( ) ( ) ( ) ( ) ( ) ( )<br />
Aşırı ( ) ( ) ( ) ( ) ( ) ( )<br />
İştah<br />
Normal ( ) ( ) ( ) ( ) ( ) ( )<br />
Az ( ) ( ) ( ) ( ) ( ) ( )<br />
Çok ( ) ( ) ( ) ( ) ( ) ( )<br />
Yoğunlaşma<br />
Normal ( ) ( ) ( ) ( ) ( ) ( )<br />
Orta sorunlu ( ) ( ) ( ) ( ) ( ) ( )<br />
Kötü<br />
Enerji düzeyi<br />
( ) ( ) ( ) ( ) ( ) ( )<br />
Canlı ( ) ( ) ( ) ( ) ( ) ( )<br />
Uyuşuk ( ) ( ) ( ) ( ) ( ) ( )<br />
Yorgun<br />
Diğer durumlar (ilaç y.e.)<br />
( ) ( ) ( ) ( ) ( ) ( )<br />
Huzursuzluk ( ) ( ) ( ) ( ) ( ) ( )<br />
Sinirlilik ( ) ( ) ( ) ( ) ( ) ( )<br />
Kabızlık ( ) ( ) ( ) ( ) ( ) ( )<br />
Cinsel istek azl. ( ) ( ) ( ) ( ) ( ) ( )<br />
47
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