HST Failure Log

APSM HST Failure Log
Patient Name*
Patient MRN#*
Date of Recording

MonthDayYear
Date
Type of Device*
Nox T3s Serial #*
SleepView Serial #
Reason for Failure
Patient Error Details*
Plans to Avoid Future Errors*
Device Malfunction Details*

Flow Sensor failedPulse Oximeter FailedDevice did not turn onDevice did not recordDevice shut off during recordingRecording not saved or available for downloadBattery FailureOther
Device Performance Verification*
Additional Description of In-Office Testing performed
Name of Tech Completing Log Entry*
Should be Empty:

APSM HST Failure Log