Quality Control Feedback Form for Sleep Study

 

Sleep Study Quality Control Feedback Download

 

Quality Control Feedback Form

 

 

 

Recording Tech: _______________________ Scoring Tech: ________________________

 

 

Scorer’s Feedback:  

Adequate acquisition baseline/treatment             Yes       No

Instrument calibrations completed                      Yes       No

Bio-Calibrations completed                            Yes       No

Artifact recognition/ intervention                    Yes       No

Adequate CPAP titration                                 Yes       No

Patient paperwork completed                             Yes       No

 

Scoring Tech Comments:_____________________________________________________

 

 

 

 

 

 

Interpreting Physician’s Feedback:

 

EEG Recording Quality Satisfactory                   Yes       No

Other channel recording quality Satisfactory       Yes       No

Adequate treatment titration                              N/A     Yes       No

Overall quality of recording                           Excellent     Satisfactory   Marginal     Poor

Scoring quality satisfactory                              Yes       No

EKG recording/scoring satisfactory                     Yes       No

 

Notes:____________

 

 

Physician signature________________       Date:___________

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