Bipolar

Patient reports episodes of elevated or irritable mood lasting at least [text name="duration_manic" default="1 week"], along with increased energy or activity. During these times, [select name="pronoun_1" value="he|she"] experiences: [checkbox name="manic_symptoms" value="inflated self-esteem or grandiosity|less need for sleep|more talkative than usual|racing thoughts|easily distracted|increased goal-directed activity|involvement in risky activities"].

[select name="pronoun_2" value="He|She"] also reports periods of low mood or loss of interest lasting at least [text name="duration_depressive" default="2 weeks"]. During these times, [select name="pronoun_3" value="he|she"] experiences: [checkbox name="depressive_symptoms" value="feeling sad or empty|loss of interest in activities|changes in weight or appetite|trouble sleeping or sleeping too much|feeling restless or slowed down|low energy|feelings of worthlessness or guilt|trouble concentrating|thoughts of death or suicide"].

These mood changes affect [select name="pronoun_4" value="his|her"] daily life and ability to function.
Patient reports episodes of elevated or irritable mood lasting at least , along with increased energy or activity. During these times, experiences: .

also reports periods of low mood or loss of interest lasting at least . During these times, experiences: .

These mood changes affect daily life and ability to function.

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Sandbox Metrics: Structured Data Index 0.75, 8 form elements, 48 boilerplate words, 2 text boxes, 2 checkboxes, 4 drop downs, 22 total clicks
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