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Hook Up Technologist Name
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Referring Provider
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Monitoring Technologist Name
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Study performed in Room Number
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Type of Sleep Study
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EEG was normal
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EEG comments free text
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Snoring
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Snore Scale
/
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PLMS
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Bruxism
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Loss of Rem Atonia or abnormal movements during REM sleep
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Seizures/Parasomnia observed
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Describe unusual behaviors, seizures or parasomnias
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Oral Venting
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SaO2 Nadir
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EKG
• • •
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EKG free text
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Sleep Stages Attained
• • •
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Sleep Positions attained
• • •
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Patient met Split Night Criteria
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Oxygen applied
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LPM of O2 used free text
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Was a sleep medication taken
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Sleep Medication Taken
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Technical or Equipment Problems
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Any patient related conserns like anxiety, pain , claustrophobia, cough etc)
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Positive Airway Pressure summary
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Mask used
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Tech Score Summary
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