HST - Documentation of Pt. Understands Instruction & Con

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HST - Documentation of Pt. Understands Instruction & Con

Postby sleepchick17 » Mon Sep 23, 2013 8:38 pm

I'm curious if anyone has any type of form they have their patients sign stating they understand the instructions for using the HST. I also am interested in seeing examples of consents for HST's that are being used.

Thanks!
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Postby SCNVsleep » Tue Sep 24, 2013 2:46 am

This is ours. Feel free to copy/modify/paste as needed. This assumes you have a lab specific Assignment of Benefits and Consent for Treatment. If not, this needs a LOT added to it. I am happy to help if needed.

By signing below, I agree to this AGREEMENT and the TERMS and CONDITIONS enclosed. I have received the Home Sleep Testing equipment listed above in good condition. I have been adequately educated in its proper use by qualified personel. I have received a description of the services and understand the responsibilities I and the provider have. I agree to proceed with the care and services offered by the provider with the understanding that this agreement may be reviewed by the provider and myself for the purposes of clarification, alteration, or discontinuance. I authorize the release of any medical information needed to process any claims for reimbursement related to the Home Sleep Test.

Further, I understand that by signing below that
• I am receiving this equipment for the purpose of conducting a Home Sleep Study as ordered by my physician.
• I am responsible for the return of the device within three (3) days of receipt and have been provided with a pre-posted mailer for this purpose.
• I understand I will be charged a $50 per day late fee if the device is not returned within three (3) days of receipt.
• I understand I will be charged $1,000.00 if the device is not returned within seven (7) days of my receipt.
• I understand that if the device is to be sent to me, it will be sent with “Signature Required”. I will ensure that someone of legal age will be available to accept delivery on the scheduled date.
• I agree to pay a $250 cancellation fee if, once equipment has been dispensed to me, I am refuse to perform the Home Sleep Test as ordered by my physician.


By signing below, I understand and fully agree with these terms and conditions.


__________________________________________________________
Patient or Legal Guardian Signature Date
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Postby somnonaut » Tue Sep 24, 2013 3:47 pm

How does the patient know that he/she is "...have been adequately educated"?
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Postby sleepchick17 » Tue Sep 24, 2013 6:27 pm

Thanks SCNVsleep, that is helpful information. I am still trying to determine what needs to be documented and signed by the patient stating they have been adequately educated on the use of the HST equipment as somnonaut also stated.
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Postby labman2 » Tue Sep 24, 2013 8:14 pm

somnonaut wrote:How does the patient know that he/she is "...have been adequately educated"?


I think this is an even bigger issue when the RT (or driver! :D ) delivers the CPAP mask and machine and does a quick demo! - :wink:

A far as the HST, I believe if you demonstrate how the HST is to be used, provide written instructions, and a DVD for review... and answered all questions as well you pretty much have covered it all.

Unless the patient only speaks Spanish or such! :oops:
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Postby somnonaut » Tue Sep 24, 2013 11:57 pm

So the wording might be better as:
"I have been educated and will do my best to perform the said functions contained within this education to perform the study."
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Postby SCNVsleep » Wed Sep 25, 2013 4:40 am

No one should sign anything ever saying they understand something without actually understanding it. Whether its a car loan, lease agreement or HST delivery ticket.

As I have explained in multiple HST threads, we do not just mail a recorder to the patient (nor WILL we as long as I am Director). They come into the lab for delivery and education. My staff fully demonstrates and educates the patient on not only how to use the equipment, but how to determine if they got a clinically acceptable recording.

If the patient does NOT understand any piece(s) of the instruction they should not sign the agreement until they are comfortable with the instruction.
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Postby somnonaut » Wed Sep 25, 2013 2:08 pm

Still, the word adequately is loaded.
Maybe wording it that they have been satisfactorily educated and will make an attempt to perform the test as educated, or something along those lines. Adequately assumes there is some measure of adequateness being met.
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documentation

Postby izzy » Wed Sep 25, 2013 5:42 pm

How do some just mail the unit out? Doesn't the patient meed to sign forms like the Condition of Service and Authorization for disclosure of health information?
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