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Restless Legs Syndrome

HISTORY:
 for  
Severity: 
Pattern: , 
Worsening factors: 
Treatments tried: , 










Other elements:

EXAM:
General appearance: 
Vital signs: , BP , HR , RR , SpO2  %, Temp °
Extremities: , , cap refill , pulses , 
Neurologic: cranial nerves , strength , sensation , reflexes , cerebellar function , gait 
Mental status: , , speech , mood , thought process , , judgment 

ASSESSMENT:
 
DDx: 

PLAN:
- Blood work: , , , , , , 
- Sleep study
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- Stretching exercises before bed
- Regular exercise
- Good sleep hygiene
- Avoidance of caffeine
- Avoidance of alcohol
- Smoking cessation counseling
- Referral to neurologist
- Referral to sleep specialist
- Follow-up in  
- Return if symptoms worsen, if new symptoms develop such as pain or numbness, or if symptoms do not improve with treatment