Sleep Therapy Efficiency Program [STEP]

REMOTE PAP MONITORING SERVICES

Informed Consent

Remote PAP Monitoring (“RPM”) is the collection of health data outside of a clinical setting (for example, while you are at home or at work) and transmission of that data to your healthcare provider for evaluation. The type of health data collected may include information about how you use your CPAP machine, respiratory rate, dates and hours of successful/non- successful use, leak rate, AHI (and respiratory event calculations that the machine records), current settings and modalities of the PAP machine, and other physiologic data that can help your physician or other healthcare provider monitor your health and make treatment recommendations. If you do not understand or agree to any or all of the information below, do not sign this agreement.

Risks and Benefits of RPM

RPM services allow your healthcare provider to monitor your health on an ongoing basis in- between visits. This may help your healthcare provider identify issues that need to be addressed sooner than they would without RPM and allows you to communicate your information to your provider without having to travel to your provider’s office. RPM relies on devices and an internet connection to transmit data and deficiencies in the connection may result in missed readings or failure to transmit information.

RPM Frequency of monitoring:

RPM monitoring will occur monthly until your compliance has been met for a minimum of 6 consecutive months. Compliance is considered the use of the device for greater than 4 hours per night and/or 16/30-31 days of use per month.

Once you are considered as compliant, compliance monitoring will occur 1x every 6 months.

By signing below, you acknowledge the following:

● Your physician or other healthcare provider has explained to you what RPM means, the type of health data that will be collected, and how it will be used in your care.

● You are aware that your health data will be collected and digitally transmitted from your device to your healthcare provider in a safe and secure manner to maintain the confidentiality of your healthcare information.

● You will not transmit or allow to be transmitted the health data of any individual other than your own.

● You have the right to “Opt Out” by submitting a request in writing at any time.