Pima Lung & Sleep, PC

DOS:

PATIENT 1:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 2:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 3:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 4:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 5:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 6:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 7:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 8:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 9:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 10:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 11:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 12:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 13:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 14:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 15:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 16:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 17:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 18:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 19:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report:

PATIENT 20:

Patient: DOB: Age: Greenway ID#:

Lowest O2 Saturation = % on lpm at

HR Range Calculated per Duke Guidelines

Time: bpm to bpm

HR Range Achieved with Today's Testing

Time: bpm to bpm

Comments:

Follow Up Clinic Appointment Date:

Next annual 6MW/12MW Date:

Upload 6MW or 12MW Report: