ME/CFS: ACTIVITY AND DELAYED-SYMPTOM DIARY
For discussion with a clinician

Record ordinary life. Do not provoke symptoms or increase activity to test
capacity. This is not a diagnostic score or a treatment trial plan.
Keep entries short; skip them if recording adds to symptoms. A caregiver
may record observations with your agreement.

Name or initials: __________________  Dates covered: __________________
Completed by: ______________________  Discussion date: ________________

MY USUAL RECENT BASELINE
Symptoms and daily abilities: ________________________________________
_____________________________________________________________________
Help I usually need: __________________________________________________
Two or three meaningful daily abilities to describe (no testing):
1. __________________________________________________________________
2. __________________________________________________________________
3. __________________________________________________________________

ACTIVITY ENTRY (copy this section as needed)
Date/time: __________________  Approximate duration: __________________
What happened? Include relevant physical, cognitive, emotional, sensory,
or upright demands: __________________________________________________
_____________________________________________________________________
Position: sitting / standing / reclining / mixed / other: _____________
Rest before/after and help received: __________________________________
Recent sleep and other relevant events: _______________________________
Symptoms BEFORE activity: ____________________________________________
Symptoms DURING/SOON AFTER: ___________________________________________
Activity completed / shortened / abandoned: __________________________

FOLLOW-UP (record actual dates, even if symptoms are unchanged)

NEXT DAY - Date/time: _________________________________________________
New activities, rest, and other changes: ______________________________
Symptoms, including fatigue, pain, thinking, sleep, flu-like feelings,
or upright symptoms as relevant: _____________________________________
Any worsening started at: ____________________________________________
Daily abilities and help needed: _____________________________________

SECOND DAY - Date/time: _______________________________________________
New activities, rest, and other changes: ______________________________
Symptoms and any delayed worsening: __________________________________
Any worsening started at: ____________________________________________
Daily abilities and help needed: _____________________________________

LATER FOLLOW-UP (repeat if needed) - Date/time: ________________________
Activity/rest context: _______________________________________________
Symptoms and daily abilities: ________________________________________
Back to usual recent baseline? Yes / No / Unsure
If yes, date/time: ____________________________________________________

CONTEXT FOR THE CLINICIAN
Medication/supplement/routine changes already made, with dates:
_____________________________________________________________________
Other illness, sleep disruption, unusual demands, or support changes:
_____________________________________________________________________
Most important change or question: ___________________________________
_____________________________________________________________________

Keep the original sequence, including unchanged days. This record cannot
identify a cause on its own. It can help discuss delayed symptoms,
changes in function, activity demands, and care needs.