Quality Control Feedback Form for Sleep Study

Sleep Study 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:___________