Epworth Test
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Epworth Test

Consent Cardio-Respiratory Sleep Polygraphy – With WatchPAT device 

MANDATORY REQUIREMENTS:

  • No pacemaker.
  • Valid medical prescription for cardio-respiratory sleep polygraphy (sleep apnea test)
  • Possession of a smartphone or tablet with Bluetooth connectivity and Internet access.
  • Ability to download the WatchPAT app (Itamar Medical) and accept its terms and conditions.

PURPOSE OF THE TEST

In-home screening test to obtain data that will be used to determine the presence of a sleep disorder.

CONSENT

  1. I have read the required conditions and meet all these criteria.
  2. I understand that the clinical data are collected from the Clinique de Santé Respiratoire des Sommets initial assessment questionnaire which I will complete to the best of my knowledge.
  3. I understand that the pulmonologist interpreting the results may not have met me personally.
  4. I am aware that the pneumologist’s recommendations will be provided for information purposes only and must be validated and discussed with my requesting physician, or directly with the pneumologist if necessary.
  5. I understand that if I refuse to complete the prescribed test following receipt of the WatchPAT equipment, no refund will be possible.
  6. I understand that if I am unable to interpret the test data, the test will be repeated at the expense of the Clinique de Santé Respiratoire des Sommets. I will have a maximum of 3 months to benefit from this return at no additional cost.
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