| RPT |
.| .| Snoring, Tired, Observed, Blood Pressure| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran:
<.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | STOP Score: <-STOP->| |
High risk of obstructive sleep apnea: a STOP score of 2 or more| Low risk of obstructive sleep apnea: a STOP score 1 or less| | | Questions and Answers| | 1. Do you snore
loudly (louder than talking or loud enough to be heard through closed doors)?| <*Answer_6517*>| 2. Do you often feel tired, fatigued or sleepy during daytime?| <*Answer_6516*>|
3. Has anyone observed you stop breathing during your sleep?| <*Answer_6518*>| 4. Do you have or are you being treated for high blood pressure?| <*Answer_6519*>| |
| Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and
used in conjunction with other diagnostic activities and procedures.| $~
|
