• SCS Reception Form

  • **Please start by entering your SCS email address to assign this form to yourself.

  • (Pre-fill this page before you speak to the patient, ensuring every part is filled and updated)

  • Call the Patient..


    Hi, am I speaking with XX?

    Hi Name, it’s XX calling from Sleep Clinic Services about your enquiry. How are you today? Have I got you at a good time? (Only ask this last question if it is not a booked call.)


    [[//Acknowledgement//]]


    I see in the comments that you have some issues with xxxxxx. Tell me a little more about what you have been experiencing.


    [[//Acknowledgement//]]


    Having conversation here - Use any of the questions/comments below to respond to what the patient is saying and demonstrate you are listening.


    Yes, that’s very common | We see that a lot | Okay

    I see | I understand | I’m sorry to hear that | That's interesting


    Ask enough questions to determine the ‘Reason for call’.  Make notes. Listen. 

    The purpose of this question is simply to get the call started and also to identify the problem and provide a solution. You don’t need to take extensive notes but give the patient the opportunity to talk as much as they need to. 


    As soon as you can identify the  ‘Nature of call’, click the relevant button and move to the next section. Make note of some of their comments to save you asking those questions later.

     


    (Tick DSS Lead on Page 2 and head to the next page)


  • Contact Type

  • Home or Clinic

  • Well there's a couple of different ways to approach having a Sleep Study. Either in an attended environment like a hospital or in clinic OR a home based option which is what we provide.

     

    Do you have a preference?

     

    ONLY - If they ask what is the difference?


    The main difference between a hospital Sleep Study and a Home based one is the price, and the waiting period.


    But what I can tell you is the equipment is the same. It is a full polysomnogram unit.


    So whilst hospitals bulk bill, you need your GP to assist with booking, there can be lengthy waiting periods and then if you need treatment, there are further sleep studies required amongst other processes. Local Sleep clinics also vary with the types of sleep studies they do as well as price. You would have to google those to find something close to you.

     

    Most people do prefer a home based sleep study as they are in their own home, they feel more comfortable and it’s convenient. It records a typical night’s sleep, so your diagnosis is based on how you usually sleep, rather than what sleep you get in a strange bed and environment. Make sense?”

     

    There are certain circumstances in which it would be recommended to have a hospital or clinic based sleep study, for example if you are unsure about technology or you need extra support, or if there is a medical condition which needs to be taken into consideration.

     

    Note the below situations for those who are needing other options…

     

    If you just want to check whether you're at risk of OSA, I can send you an Apnea Risk Assessment test to do. It's free and you can do it anywhere anytime. (SnoreLab is for people who are interested in hearing whether / how loud they snore. If they already know they snore and don't particularly want to hear it, the OSARA pdf risk assessment is a more valuable thing to send them.)

     

    There are also multi channel screening devices you can get online and through pharmacies, and they are quite inexpensive and good as screening devices. But they are not advanced enough to provide a true diagnosis of the nature and severity of your condition, so they are not recognised by Medicare or the health funds, so just be aware of that.


    If the Patient wants a Hospital or Clinic

     

    Okay, if you would prefer a hospital setting, you can go to your GP and they can get you booked into the hospital for a Sleep Study. We are a full remote service and only provide a Home based Sleep Study service.

     

    You can check Google to see where their local service is if they ask..

     

    Unattended / In-Home aka Home Based Sleep Study - if the patient would like this option, select it and move to the next page.

  • Quick DSS Explanation

  • (Name), before I explain our service to you, I need to check a couple of things first. 


    Have you done a Sleep Study in the past 12 months?

     

    If yes, the patient will not be eligible for a Medicare approved sleep study. They will either need to wait until after 12 months has passed since the last sleep study or they can do it as a private patient. 


    [[//Acknowledgement//]]

  • Ok I just need to check if you are currently on or receiving treatment for Sleep apnea?

     

    If yes, the patient can proceed forward only if they are not regularly using the CPAP/APAP and they meet the medicare criteria, they are not to wear the MAS on the night of the sleep study as that will distort the findings. If someone is regularly using a CPAP, they will need to have the sleep study done in the clinic where there is the equipment available for the person to use the CPAP whilst doing the sleep study. 


    [[//Acknowledgement//]

  • Once these questions have been answered, move to the next section.


    Ok (name),  great so let me give you the key information. So first of all.


    The total cost is $790. However, if you are eligible, medicare will contribute $325 so your out of pocket expense will be $465.  


    We will go through a few assessments over the phone now to check if you meet their criteria so we know what the cost is moving forward.

     

    What happens is we send the equipment to your home and provide you with clear step by step instructions. 


    You do the Sleep Study on the night that it arrives. 


    And the very next day you pop it in the post in the satchel that is provided for you.


    When we receive the unit, the recorded data will be uploaded to a Sleep Scientist for scoring and then an independent Sleep Physician will do the formal diagnosis and the final report for us. (that can take about 10 days for the results - usually it’s quicker than that)


    Now when we receive the final report, we will let you know and arrange a phone appointment for you to talk to one of our Sleep Therapists who will take you through the report step by step and explain it in plain english so you understand what it means. You’ll also get a copy sent to you at that time.


    So how does that sound?


    [[//Acknowledgement//]]


    If not, ask if they would like an email with a self-assessment checklist which they can go through in their own time. 


    If yes, proceed forward to the next page to go through the Medicare questions

  • Level 3 Explanation

  • We do have a Level 3 Sleep Study option which might be suitable for you. It's $180. There's no requirement for Medicare and for a referral either.

    The device is simple in which you put it on your finger, so no leads, and the sensors will monitor your heart rate, heart rate variability (HRV), and the changes in breathing including your oxygen levels. The data is then sent live to an app on your phone which uses special calculations which can tell us if you have sleep apnea.

    It can also tell us about the efficiency of your sleep, any disruptions that may be occurring, and the general health of your heart health and how you are breathing at night.

    Same sort of process as the Level 2 Sleep Study in that we send it to you, there are instructions to connect it to an app on your phone and the next day you send it back in the satchel provided. We get the results quicker and it produces the same results as the Level 2 Sleep Study. You will also have a phone consultation with the Sleep Therapist to go through the results.

    Does that sound like an option for you? 

     

    If yes, please then check that over some points to ensure it is still suitable.

     

    Great, let me check a couple of things to make sure it is still okay for you and then if you don't mind I will go through a few questions with you just so the Sleep Therapist will have some information and we can book you in.

     

    Note: Only say you will go through the questions if you have not already gone through the screening. If you have, please ask the questions below and go to Referral Check.

     

  • *If you have not already spoken to them about private health, let them know that this type of sleep study would not be accepted for treatment purposes if they would like to claim a rebate.

  • *If proceeding forward, go through to the next page to go over the Epworth Sleepiness Questions. There is no need to go through Contraindications.

  • Conditions for a Home Sleep Study

  • So (Name), the next step is to go through these assessments to see if you meet the medicare eligibility criteria . 


    Before I do I just need to check any pre-existing conditions you may have which could affect your eligibility. Okay?


    Go through the list below at this point.

     

    Using common sense here….if they are not sure about a question….

    If the patient answers YES to any of the questions, assess the suitability of the patient in continuing on in doing a home based sleep study. For example, if the patient has a disability do they have the support? If the person has night terrors, when was the last one they had, how regular is it and when they have them do they thrash about violently or more just waking up suddenly.


    If a patient answers NO, please move to the next page.

  • Epworth Sleepiness Scale (ESS)

  • Okay, now I’m going to take you through the Epworth Sleepiness Scale.


    What I’m going to do is give you some different scenarios and I want you to tell me 'what is the likelihood of you feeling sleepy'. Not actually fall asleep, just that feeling of drowsiness.  


    Your possible answers can be No chance, slight, moderate, or high.


    So how likely is it you would feel sleepy if you were:


    [[Refer to ESS lists below and tally the score]]

  • If 8+ say, "That's all the questions for the first assessment. Your score satisfies one of the key criteria for Medicare coverage, so let’s go a little further to confirm your eligibility."


    If less than 8 say, ""Based on your score, you don’t satisfy the Medicare eligibility criteria, which means it will cost you the full $560 to proceed as a private patient or we do have another option of a Level 3 Sleep Study if you would like to hear more information.

     

    If they ask why they are not eligible, explain that unfortunately, medicare is very strict on what they will cover so if you are not sleepy or drowsy during the day it’s not as high a likelihood of you having sleep-disordered breathing.

  • Work info, DOB, BMI, Neck & Waist Size

  • Now this next assessment is a little bit more detailed. 


    So firstly (name), can I ask what your occupation is?


    How is your sleep affecting your work performance? 


    If they are a pensioner or unemployed, talk to them about possibility of doing DSS as a public patient instead (they may get treatment as well as DSS bulk-billed and probably unaffordable through us - do not say that to them)


    NOTE: This is a good time to listen as they express how they are being affected in their day to day life.  Let them talk as much as they need to without letting them digress too much. This is good for rapport building. 

  • Alright, now I just need to ask some things to check you against what’s known as the STOPBANG criteria.


    STOPBANG Acronym: Snoring, Tired, Observed apnoea, blood Pressure, BMI, Age, Neck, Gender

     

    What is your Date of Birth 

    (Note 1:  Must be over 18.  ;Note 2:  Age over 50 is part of OSA50 criteria)

  • Now next I need to calculate your Body mass index. Can I please have your height and weight?

    (record these)

  • Only get these measurements if it helps the patient to meet the Medicare criteria, or if BMI is 30 or above. Use common sense.


    We have 2 other measurements that we require. 


    For Men


    What size shirt do you normally wear?


    What size pants do you normally wear?


    Excellent, thank you.

     

    For Women (If they are at home)


    I will need to get your neck and waist measurements.


    Do you happen to have a tape measure nearby? 


    If they don’t, ask if they can get it for you when they get home, and send the measurements through. 


    Note:


    Neck circumference is part of STOPBANG criteria. It is easier asking for a man’s shirt size as the collar measurements give us an indication of the neck size. Use the sizing chart for cms.  For women it’s more challenging as the shirt size can take into account chest as well.  if the BMI is higher ask if they have access to a measuring tape if they can let you know what it is. 


    Waist circumference is part of OSA50 criteria and very important to ask a woman to measure waist if they don’t necessarily meet the Stop Bang criteria. Again it is easier for a man’s pant size to give us an indication of their waist whilst women we need to ask them to measure, particularly if they are in the higher BMI range. 

     

    Continue to the next page for the rest of the Stopbang criteria

  • Neck size? Collar size? Shirt size? Normal, Large or XL?

    **(Medicare Criteria: Female 41cm+ or Male 43cm+)

  • Waist size? Belt size? Trouser size? Normal, Large or XL?

    **(Medicare Criteria: Waist = Female 88cm+ or Male 102cm+)

  • The STOPBANG Criteria (3+)

    *Medicare criteria: total score must 3 and above

  • Okay, just a few more things here…


    Note: Many of these questions you would have already possibly answered when you were having a conversation with the enquirer. Only ask the questions in which you haven’t received the answers to just yet.


    Once you have ticked boxes based on the answers given, go to the next page

  • The OSA50 Criteria (5+)

    *Medicare criteria: total score must 5 and above

  • Now we have the OSA criteria so I’m just going to complete these…bear with me. 


    Note: You do not need to go through these questions with the enquirer. They have already been answered. Just fill in the boxes where required.


    Once you have ticked boxes based on the answers already given, go to the next page

  • Other Conditions

    Common Symptoms & Consequences

  • Now I’m going to go through some common symptoms with you. 

     

    Each of these can be linked to having a sleep disordered breathing condition and the Sleep Physician will want to look at this information as well.

     

    Once you have answered these questions, go to the next page

  • Referral Check

  • Okay, now that is all done you have also met the criteria for the 2nd assessment. 

    So moving forward, that means the cost will be $465 for you and the remainder is covered by Medicare. But, we will need a referral.


    If they don’t meet the criteria for Medicare


    Okay now unfortunately you have not met the criteria for the 2nd assessment. 

    So moving forward that means the cost for you will be $790. Do you want to go ahead and proceed?

     

    IF YES


    Okay, I’m going to skip the referral as a private patient you don’t need it but that information you already provided is useful for the Sleep Physician as well 


    Now there are a couple of options here. I can either send you a prefilled referral today with the answers you have already provided, populated into it.

    You just take that to your GP to sign and they’ll send it back to us.


    OR, if you prefer a simpler option, or your GP is a bit hard to get into quickly, there is an online GP who refers to us. He just charges a small fee of $45 but that way you don’t have to do anything. We’ll send it to him for you. He’ll sign it and send it back to us. 


    What would you prefer to do? Ok, I’m just going to make a note of that…


    [[//Answer//]]

    Make a note on the form of the choice


    How soon would you like to arrange to book the sleep study? So - Okay, so let's go through the next steps in booking your sleep study.

    If private pt we don’t need medicare details so skip the next part


    Go to the next page


  • Medicare Card Details

  • Do you have your medicare card handy?


    The patient’s sleep study unit will only be dispatched if we have all of their Medicare card details and it is valid. Please ensure you fill out all the details.


    Go to the next page

  • Full Legal Name Details

  • Okay, I just need to confirm your name details on your medicare card please.

     

    You should already have their first name but check for spelling and what their preferred name is.  Also, the middle initial is usually stated in their Medicare Card, but for this instance, you will need to ask for their FULL MIDDLE NAME.


    Once you have the filled out the full details, go to the next page

  • PLEASE NOTE: Details below should be aligned with the details on their MEDICARE CARD, all except the MIDDLE NAME, we will need their full middle name not just the initial.


  • Address Details

    **Please be reminded to *DOUBLE CHECK* the Patient's address by using the link below before finalising or submitting the reception form. Please check also the spelling before submitting.

  • Next, can I get your address?

     

    Home address first and then the delivery address


    Some people will prefer to have the unit sent to another address. If they do, also take down their home address. Check with Google Maps if you think the spelling is incorrect.

     

    Once you have filled out the full details, go to the next page

  • *OPEN THIS LINK IN A NEW TAB to VERIFY ADDRESS on Google*

  • Different Delivery Address Details

    **Please be reminded to *DOUBLE CHECK* the Patient's address by using the link below before finalising or submitting the reception form. Please check also the spelling before submitting.

  • *OPEN THIS LINK IN A NEW TAB to VERIFY ADDRESS*

  • DSS Date & Delivery Time

    Please check the estimated delivery time below

  • Now let’s find a date for your Sleep Study.


    Okay (name), I’m just going to bring up the booking calendar and calculate the postage delivery time? If you can bear with me for one moment please.


    Tip: Have a physical calendar next to you on your desk or use the calendar on the bottom right-hand side of your screen. 

    It looks like we can dispatch on (Date)  which means we can book you in for (Date). We normally allow extra days for Australia Post so we can ensure it gets to you on time but if it comes earlier please feel free to do the sleep study on the day it arrives. 


    How does that sound?

     

    (Note - only say this if seeing their own doctor) Are you able to see your doctor before the dispatch date, because we will need the referral before we are able to send the unit to you. ...otherwise your sleep study booking will be cancelled and it will be given to someone else. 

     

    Once you have booked in the sleep study, go to the next page

     

     

  • *PLEASE DON'T BOOK SLEEP STUDIES ON WEEKENDS AND DURING PUBLIC HOLIDAYS.*

  • ESTIMATED DELIVERY TIME GUIDELINE (Weekends Not Counted)

    Important Note: Any sleep study booked in the couple of weeks before Christmas, please add 1 extra day to postage times.

    NSW/SA - 2 days
    VIC - 2 days
    WA - 4 days
    ACT - 3 days
    TAS - 2 days
    QLD - 2 days
    NT - 2 days
    Regional Areas - 4 days

     ***PLEASE DO NOT BOOK 1-DAY DISPATCHES, ESPECIALLY THOSE THAT DON'T HAVE A REFERRAL YET, THIS INCLUDES ONLINE GP REFERRALS**

    For a more accurate estimation of delivery time, click on this link and enter the postcode from MURRUMBA DOWNS QLD 4503 and enter the postcode which the parcel is being delivered to: https://auspost.com.au/parcels-mail/calculate-postage-delivery-times/#/

     

  • *PLEASE ENSURE TO RESERVE AND BOOK THE DISPATCH DATE OF THE DSS UNIT BELOW* - this only need to be done 'ONCE'

  • Payment Details

  • CLICK HERE to access *BPOINT PORTAL

    CLICK HERE to access *BPOINT doc

  • I’m going to take your payment details next. Will that be by VISA or Mastercard?


    Take down card number, expiry date, name, 3 digits on back.


    When I get off the phone with you today it’ll take me about 5 minutes to process the payment and finalise your booking.  


    Some points to note:


    • If someone books a date WITHOUT PAYING, please advise that it is a TENTATIVE BOOKING and that PAYMENT IS REQUIRED 2 WEEKS PRIOR TO DSS Date.

     

    • Direct Deposit is ONLY available for people who need to pay this way, particularly if they don’t have a credit card or don’t like to pay over the phone but it is not an option we provide unless they ask. 

     

    Go to the next page


  • ****PLEASE NOTE:

    • $445 (Pensioners Discount - Age 67+ only. Not to be offered, only if asked)
    • $790 (Max Medicare Patients) - Please note that the Medicare Claim documentation receipt can only be provided by the Sleep Physician and Sleep Scientist once your sleep study is completed and we have your sleep study results on hand. Because of this, there had been no Medicare Claim processed under your name as of yet.

      We wish to provide you the Medicare Claim documentation receipt sooner but this is completely out of our hands. We will need to abide by a step-by-step process that Medicare requires. (Medicare requires a report from the Sleep Physician and Sleep Scientist which can also only be provided after you have finished and completed your sleep study. Without a doctor completing the report, they cannot invoice Medicare and therefore we cannot give you the Medicare claim document until the reporting of the sleep study is finished.)

      We will make sure to keep you posted as soon as we have your results and the Medicare Claim documentation receipt on our hands.

  • Cancelof

  • Details Check & Call Outcome

  • Now, I’m going to just check if I have your correct email address. Is it xxxx

  • Good. Now, as one of our privacy protocols we always ask for your permission before we use your email address. We'll only ever use it to help with your enquiry and overall health and wellbeing. So, do I have your permission

  • Okay good, so you're going to get an email from us soon that will explain everything.  

     

    When the unit is dispatched you’ll get an email with a tracking number so you can see exactly which day it will arrive.  In that email you‘ll also receive a link to a few short instructional videos. 

     

    Pre watch them and if you have any questions give us a call. We will have a Sleep Therapist on standby until 8pm QLD time that evening to help with any issues if you need it. 

     

    After your normal nightly routine just go to sleep when you're ready. 

     

    Make sure you don't use any other form of sleeping aids such as a dental splint on the night of the study as it will impact on the diagnostic results. Okay? Everything else should be the same as any other night. 

     

    Pause for second

     

    The next morning, you just pop the recorder into the satchel we provide and drop it at the Post Office. 

     

    I need your commitment to return the unit on the day after the study. 

     

    We have a strict process on the return of the units because we have people waiting for their study so we need to prep the unit but also we want to get your data sent to the Sleep Scientist for scoring as soon as possible.

  • Great.

    Before we wrap up, I also just need to quickly check that you’re happy for us to share your sleep study results for your work medical, where needed? (e.g. Jobfit or Aurizon) 

     

  • Wonderful.

     

    When we get your results back from the sleep physician, we’ll organise a time to go through them with you in detail so you know exactly what you’re dealing with. 

    Does that all make sense? Do you have any questions before we finish up?

    Okay great. Well look out for that email and enjoy the rest of your day.


  • DSS Terms (Prov DSS)

    *Please select & copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • Prov DSS: Awt CPF payment. Signed ref received.

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date:  (Please input date today)
    Prov Sleep Study Date: 
    Signed GP Referral Received. Awt CPF Payment. 

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Signed GP Referral Received. Awt CPF Payment. AWT Medicare Details.

  • Prov DSS: Awt CPF via credit card & signed referral

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Awt CPF and Signed Referral. 

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Awt CPF and Signed Referral. AWT Medicare Details.

  • Prov DSS: Awt CPF via direct deposit & signed referral

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Awt CPF via direct deposit and Signed Referral. 

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Awt CPF via direct deposit and Signed Referral. AWT Medicare Details.

     

  • Prov DSS: CPF paid. Awt signed ref

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    CPF Paid. Awt Signed Referral. 

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    CPF Paid. Awt Signed Referral. AWT Medicare Details.

  • Prov DSS: CPF & Online GP paid. Awt Dr Risto referral.
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Prov Sleep Study Date:
    CPF and Online GP Paid. Pre-filled Referral sent by CCS to Dr Risto.

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    AWT Medicare Details. CPF and Online GP Paid. Pre-filled Referral sent by CCS to Dr Risto.

  • Prov DSS: Awt CPF & Online GP Payment.
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Awt CPF and Online GP Payment. CCS to send Pre-filled Referral to Dr Risto once PAID .

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    AWT Medicare Details. Awt CPF and Online GP Payment. CCS to send Pre-filled Referral to Dr Risto once PAID .

  • Prov DSS: Private Pt. Awaiting CPF & Medicare Component payment.
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Awt CPF & Medicare Component Payment. No Medicare or Signed Referral needed - Private Patient.

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    AWT Medicare Details. Awt CPF & Medicare Component Payment. No Medicare or Signed Referral needed - Private Patient.

  • Prov DSS: Level 3 Study Patient - Awaiting L3 CPF payment.
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    LEVEL 3 STUDY PATIENT. Awt L3 CPF Payment. No Medicare or Signed Referral needed.
    ______________________________________________

  • Prov DSS: (MAX Medicare) CPF & Medicare Component Paid. Awt Ref
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Max Medicare CPF Paid. AWT Signed Referral.

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    AWT Medicare. Max Medicare CPF Paid. AWT Signed Referral.

  • Prov DSS: (Free DSS). Awt signed ref

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Free DSS, Referred by patient. Awt Signed Referral. 

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    AWT Medicare. Free DSS, Referred by patient. Awt Signed Referral.

  • Prov DSS: (Free DSS). Online GP paid.

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Free DSS, Referred by patient. Online GP paid.

     

    **If Medicare is still missing, copy the DSS Terms Below instead**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    AWT Medicare. Free DSS, Referred by patient. Online GP paid.

  • Prov DSS: (Jobfit Booking) Private Pt. Awaiting payment..

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Private Pt, Referred by Jobfit. All good to dispatch, Jobfit will settle the payment.

  • Prov DSS: (Aurizon Booking) Private Pt. Awaiting payment..

    **Copy the DSS Terms Below**

    ______________________________________________

    Current Date: (Please input date today)
    Prov Sleep Study Date:
    Private Pt, Referred by Aurizon. All good to dispatch, Aurizon will settle the payment.

  • DSS Terms (Finalised DSS Booked)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • DSS Finalised: Private Pt. $790 paid or $615 (MAS review) paid.
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Finalised Sleep Study Date:
    CPF & Medicare Component Paid. No Medicare or Signed Referral needed - Private Patient.
    ______________________________________________

  • DSS Finalised: Max Medicare Threshold Claim Patient. $790 paid. Signed ref received.
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Finalised Sleep Study Date:
    Max Medicare Threshold Claim Patient. CPF Paid. Signed Ref received.     ______________________________________________

  • DSS Finalised: CPF Paid & Referral Received
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Finalised Sleep Study Date:
    CPF Paid & Signed Referral Received.
    ______________________________________________

  • DSS Finalised Level 3 Study PT: $180 Paid.
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Level 3 PATIENT. $180 Paid. No Signed Referral & Medicare Required. SleepImage Ring will be dispatch by Logistics Team.
    ______________________________________________

  • DSS Finalised (Free DSS). Signed Referral Received
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Finalised Sleep Study Date:
    Free DSS, Referred by patient. Signed Referral received

  • DSS Terms (DSS Re-scheduled/ Redo)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • DSS Re-scheduled: New Sleep Study Date
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Re-scheduled Sleep Study Date:
    ______________________________________________

  • DSS Redo Sleep Study Date
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Redo Sleep Study Date:
    ______________________________________________

  • DSS Terms (Awaiting Feedback)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • DSS Re-scheduled: Awaiting Feedback
    **Copy the DSS Terms Below**
    ______________________________________________
    Current Date: (Please input date today)
    Awaiting feedback from lead.
    ______________________________________________

  • DSS Terms (Follow Up Needed)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • DSS Re-scheduled: Follow Up Needed
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Follow up Needed.
    FUP Date & Time:

    ______________________________________________

  • DSS Terms (Non Prospect )

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • Non Prospect Enquiry
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Non Prospect. Lead Lost. (PLEASE STATE REASON). No Other FUP Required.
    ______________________________________________

  • DSS Terms (Uncontactable)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • Patient Uncontactable. (No response from patient)
    **Copy the DSS Terms Below**
    ______________________________________________


    Current Date: (Please input date today)
    No contact with Pt. No Other FUP Required.
    ______________________________________________

  • DSS Terms (Not proceeding)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • Caller not proceeding: Went elsewhere
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Not proceeding with sleep study. Went elsewhere. Lead lost. No other FUP required.

    ______________________________________________

  • Caller not proceeding: Change of mind
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Not proceeding with sleep study. Change of mind . Lead lost. No other FUP required.

    ______________________________________________

  • Caller not proceeding: Cancelled sleep study
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Not proceeding with sleep study. Cancelled sleep study. Lead lost. No other FUP required.

    ________________________________________

  • Caller not proceeding: Other (Please state reason)
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Not proceeding with sleep study (please put reason). Lead lost. No other FUP required.

    ________________________________________

  • DSS Terms (No answer/response)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • Pr did not answer: 1st call.
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    1st call. No contact with Pt. Left a voicemail message. 'SMS#2 - FUP Call Again?' sent. Will FUP again tomorrow for 2nd call.
    ________________________________________

  • Pr did not answer: 2nd call.
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    2nd call. No contact with Pt. Left a voicemail message. 'SMS#3 Acuity' sent. If an appointment is booked, FUP with a call. If no response, send EM SAF. 
    ________________________________________

  • No response: Email SAF sent
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    No SMS response. No appointment booked through acuity. 'EM SAF' sent.  
    ________________________________________

  • Replied to EM but Pr did not answer: 3rd call.
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    3rd call. Lead replied to Email SAF but no answer. Left a voicemail. 'EM Last Call' sent.  If no response, no further action required.
    ________________________________________

  • No Email response: Email - Last Call
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Still no response. 'EM Last Call sent. No further action required. 
    ________________________________________

  • DSS Terms (FUP required)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • Pt asked for call back: FUP call booked
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Pt currently unavailable. Call rescheduled via this FUP link: https://bit.ly/321A2Ul
    FUP Date & Time:
    ________________________________________

  • DSS Terms (More info/referral sent)

    *Please copy the relevant DSS Terms below and paste to the 'Summary Notes' section.

  • More info requested: DSS Explained.
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    More info requested by the Pt. DSS explained. Pre-filled referral & cover letter sent through Jotforms.
    ________________________________________

  • More info requested: DSS Not Explained.
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    More info requested by the Pt. DSS not explained. Assessment not conducted. OSARA pdf sent. 
    ________________________________________

  • More info: Asked for a referral 
    **Copy the DSS Terms Below**
    ______________________________________________

    Current Date: (Please input date today)
    Referral requested by the Pt. Referral form sent through email.
    ________________________________________

  • Summary Notes & Comments

  • NOTE: Example of Non DSS:

    • Wrong numbers
    • Spam calls
    • Marketing calls
    • People who were not looking for a sleep study
    • People who are wanting Pap parts.

  • NOTE: Please put the latest notes down at the bottom of the SUMMARY NOTES / COMMENTS section so that we can easily see what happened throughout the call in ascending order.

  • Please input any special instructions that needs to be communicated to the Admin Team about the Patient's Booking below.

    (e.g. asking for an early date for their study/wanting to be on the shortlist, a request to expedite results, special request about delivery address & etc..)

  • NOTE: The Additional Notes for ST? section are extra details that you think would be important for the Sleep Therapist to know about the patient when they go through the results with them.

    Things like the patient's personality, temperament, or their view about sleeping with a machine and mask as a form of treatment.

    Remember the ST has not spoken to the patient before so anything that gives them an idea of who the person is based on your conversation is very helpful.

    You don't need to add any information about their DSS booking here; add additional info like: if they asked Tx questions, main reason for doing DSS, keen on AP Tx or Not, mentioned money (tight budget), If foreign do they speak English well/understand, how to pronounce their name etc

  • Follow Up Actions


  • Email Details

    *Please check/fill the details below**

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