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HME Homecare Products
Provider Information                          Referring Physician
Address:                 1086 Main Street     Name:                      Allen Jones, MD
City:                    Somerset             Group:                     Sleep Center of
                                                                         Somerset
State/Province:          PA                   Address:                   19876 Mountain Drive
Country:                 USA                  City:                      Somerset
Phone Number:            434-333-4343         State/Province:            PA
Contact:                 Julie Robertson      Postal Code:               15501
                                              Contact:                   Megan Fairfield


Patient Information
First Name:              Steven
Last Name:               Jones
Address:                 1234 Oak Street
City:                    Somerset
State/Province:          PA
Postal Code:             15501
Country:
Phone Number:            333-333-3333
Birth Date:
Height:
Weight:
Gender:                  Male
Payor Name:              PayPlan One
Insurance Id:            1201920
Patient Record:          sj-5229892938

Study Details - ID000101 (IntelliPAP Standard)
Start Date:                                   2/1/08
Study Length ( Days ):                        60
Pressure Unit :                               cmH2O
CPAP Pressure :                               10
Delay Pressure :                              4
Delay Time (minutes):                         20

Usage Statistics ( 6/1/08 - 8/12/08 )
Possible Usage Days in Range:                 73
Usage Index:                                  92%
Days with any Usage:                          73
Average Usage Duration (Hours):               4.9
Days used at least 4 hours:                   67
Standard Deviation (Hours):                   0.6




Page 1 of 2                                 Created by SmartLink Report Generator Rev.1.5.0 11/5/08
Notes
- 11/5/08 - Device ID000101 was assigned to patient
- 11/5/08 - First data received for study




Page 2 of 2                                           Created by SmartLink Report Generator Rev.1.5.0 11/5/08

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Smart Link Sample Summary Report Intelli Pap Standard

  • 1. HME Homecare Products Provider Information Referring Physician Address: 1086 Main Street Name: Allen Jones, MD City: Somerset Group: Sleep Center of Somerset State/Province: PA Address: 19876 Mountain Drive Country: USA City: Somerset Phone Number: 434-333-4343 State/Province: PA Contact: Julie Robertson Postal Code: 15501 Contact: Megan Fairfield Patient Information First Name: Steven Last Name: Jones Address: 1234 Oak Street City: Somerset State/Province: PA Postal Code: 15501 Country: Phone Number: 333-333-3333 Birth Date: Height: Weight: Gender: Male Payor Name: PayPlan One Insurance Id: 1201920 Patient Record: sj-5229892938 Study Details - ID000101 (IntelliPAP Standard) Start Date: 2/1/08 Study Length ( Days ): 60 Pressure Unit : cmH2O CPAP Pressure : 10 Delay Pressure : 4 Delay Time (minutes): 20 Usage Statistics ( 6/1/08 - 8/12/08 ) Possible Usage Days in Range: 73 Usage Index: 92% Days with any Usage: 73 Average Usage Duration (Hours): 4.9 Days used at least 4 hours: 67 Standard Deviation (Hours): 0.6 Page 1 of 2 Created by SmartLink Report Generator Rev.1.5.0 11/5/08
  • 2. Notes - 11/5/08 - Device ID000101 was assigned to patient - 11/5/08 - First data received for study Page 2 of 2 Created by SmartLink Report Generator Rev.1.5.0 11/5/08