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





Physician signature________________       Date:___________

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