5850 Coral Ridge Drive, Suite 304, Coral Springs, Florida 33076
PHONE: (877) 337-7111 FAX: (866) 677-4465
www.virtuox.net
Pulse Oximetry - Summary Report
Patient Information
miko, kyle
123
city, AL 33444
Phone: (777) 777-7777
Gender: Male
DOB: 01/10/1988
Medicare ID: 123456789a
Physician Information
Tom Brady
123
city, FL 33444
Phone: (777) 777-7777
Fax: (888) 888-8888
NPI: 1234567890
Start: 10/27/2011 4:23:45 PM
End:
SpO2 Data
Provider Information
lincare-testing
1
city, AL 33444
Phone: (777) 777-7777
Fax:
(777) 777-7777
10/27/2011 5:24:14 PM
Duration:
Pulse Data
7LPH”
2.9 (min)
Hi-Pulse
7LPH”
3.8 (min)
Low Pulse
High SpO2
99.0%
Low SpO2
80.0%
Basal SpO2
93.4%
Delta SpO2
2.9 (min)
7LPHFRQVHFXWLYH”
1.0 (min)
Artifact Events (min)
1:01
Considerations
182 bpm Oxygen
It appears this patient does NOT
54 bpm qualify for Nocturnal Oxygen per
Medicare guidelines.
0.0 minutes
Desaturation Index
Total Desaturation Events: 111
Average Events per Hour: 110
Awake SpO2
99.0%
Above are the key values to assess
qualification under Medicare Guidelines.
Desaturation
$GHVDWXUDWLRQHYHQWLVGHILQHGDVDGHFUHDVHLQ
6S2•SHUFHQWDJHSRLQWVZLWKLQDPLQXWH
ZLQGRZRIRQVHW
RAD Protocol
Delta SpO2
&XPXODWLYHPLQXWHV”0HGLFDUHUHTXLUHV
PLQXWHVRUJUHDWHUIRUR[\JHQLQ*URXS
6OHHSR[LPHWU\GHPRQVWUDWHVR[\JHQVDWXUDWLRQ”
A measurement of cumulative SpO2 readings
IRU•PLQXWHVRIQRFWXUQDOUHFRUGLQJWLPH
greater than 5% below the recorded Baseline
PLQLPXPUHFRUGLQJWLPHRIKRXUVGRQHZKLOH SpO2. Medicare requires 5 minutes or greater
&XPXODWLYHPLQXWHV”0HGLFDUHUHTXLUHV
EUHDWKLQJR[\JHQDW/30RUWKHSDWLHQW
V
for oxygen coverage in group 1.
PLQXWHVRUJUHDWHUIRUR[\JHQFRYHUDJHLQJURXS SUHVFULEHG),2ZKLFKHYHULVKLJKHU3OHDVHUHIHU
WR*URXS,TXDOLILFDWLRQGXUDWLRQDQGWHVWFRQGLWLRQ
WRVHHLISWTXDOLILHV(IIHFWLYHGDWH
Condition of Test: Overnight Room Air
Oximeter Used:
VirtuOx, Inc.
VPOD-Wrist HD, A 1 second High Resolution Pulse Oximeter (HRPO) Serial #:111111111
Private and Confidential
Page 1 of 1
5850 Coral Ridge Drive, Suite 304, Coral Springs, Florida 33076
PHONE: (877) 337-7111 FAX: (866) 677-4465
www.virtuox.net
Pulse Oximetry - Detailed Report
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
Overnight Room Air
Comprehensive Report
Recording Time:
01:00:29
Highest Pulse:
182
Highest SPO2:
99%
Excluded Sampling:
00:00:00
Lowest Pulse:
32
Lowest SPO2:
80%
Total Valid Sampling:
01:00:29
Mean Pulse:
99
Mean SPO2:
93%
Time SpO2<90:
00:03:49
6.3%
Time SpO2<60:
00:00:00
0.0%
Time SpO2<80:
00:00:00
0.0%
Time SpO2<89:
00:02:53
4.8%
Time SpO2<70:
00:00:00
0.0%
Time SpO2<88:
00:02:04
3.4%
A desaturation event was defined as decrease of saturation by 3 or more.
No events were excluded due to artifact.
There was 0 desaturation event over 3 minutes in duration
There were 111 desaturation events of less than 3 minutes duration which:
The mean high was 95.6. The mean low was 89.7.
The mean length of events that were >=10 sec & <=3 mins was: 23 sec.
Desaturation event index (number of events per hour): 111
VirtuOx, Inc.
Private and Confidential
Page 1 of 8
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
Overnight Room Air
2 Hour SPO2 / HR Report
10/27/2011 4:23:45 PM To 10/27/2011 5:24:13 PM
10/27/2011 4:23:45 PM To 10/27/2011 5:24:13 PM
VirtuOx, Inc.
Private and Confidential
Page 2 of 8
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
Overnight Room Air
Desaturation Event Details
A desaturation event is defined as a drop in Spo2 of 3 percentage points or greater within a 3 minute window of onset. The
event ends at the point in time where the saturation level makes an upward movement or when missing / invalid / artifact data
is encountered.
Desaturation Index
Total Desaturation Events Average Events Per Hour -
111
110
Events longer than 3 minutes are excluded from statistics below...
ID
Start
End
Duration
SpO2 onset
SpO2 Low
Pulse Low
Pulse High
1
4:24:08 PM
4:24:27 PM
00:00:19
94
90
92
95
2
4:26:10 PM
4:26:20 PM
00:00:10
94
91
91
94
3
4:26:45 PM
4:27:00 PM
00:00:15
94
91
91
93
4
4:27:03 PM
4:27:25 PM
00:00:22
96
91
92
95
5
4:27:32 PM
4:27:51 PM
00:00:19
97
88
71
95
6
4:28:22 PM
4:28:24 PM
00:00:02
96
91
92
92
7
4:29:00 PM
4:29:08 PM
00:00:08
97
89
92
93
8
4:29:18 PM
4:29:29 PM
00:00:11
98
94
84
85
9
4:29:38 PM
4:29:43 PM
00:00:05
98
95
88
90
10
4:29:50 PM
4:29:56 PM
00:00:06
99
93
90
90
11
4:30:15 PM
4:30:23 PM
00:00:08
97
92
88
89
12
4:30:27 PM
4:30:41 PM
00:00:14
95
91
90
90
13
4:30:45 PM
4:30:51 PM
00:00:06
94
90
91
91
14
4:30:58 PM
4:31:10 PM
00:00:12
96
89
92
92
15
4:32:20 PM
4:32:29 PM
00:00:09
96
90
54
87
16
4:32:38 PM
4:32:46 PM
00:00:08
96
90
93
93
17
4:33:00 PM
4:33:07 PM
00:00:07
96
87
92
94
18
4:33:13 PM
4:33:19 PM
00:00:06
98
84
91
91
19
4:33:33 PM
4:33:39 PM
00:00:06
95
91
91
92
20
4:33:44 PM
4:33:46 PM
00:00:02
94
91
92
94
21
4:34:08 PM
4:34:13 PM
00:00:05
95
92
92
92
22
4:34:24 PM
4:34:28 PM
00:00:04
95
90
93
93
23
4:35:33 PM
4:35:40 PM
00:00:07
96
89
91
92
24
4:36:02 PM
4:36:16 PM
00:00:14
98
89
91
95
25
4:36:34 PM
4:36:39 PM
00:00:05
95
91
92
93
26
4:36:49 PM
4:36:53 PM
00:00:04
95
82
91
94
27
4:37:44 PM
4:37:48 PM
00:00:04
95
90
94
94
28
4:38:21 PM
4:38:28 PM
00:00:07
95
92
85
85
29
4:38:32 PM
4:38:41 PM
00:00:09
96
92
83
91
30
4:38:45 PM
4:39:10 PM
00:00:25
96
93
92
95
VirtuOx, Inc.
Private and Confidential
Page 3 of 8
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
ID
Start
End
Duration
SpO2 onset
SpO2 Low
Overnight Room Air
Pulse Low
Pulse High
31
4:39:17 PM
4:39:20 PM
00:00:03
96
87
93
93
32
4:39:36 PM
4:39:43 PM
00:00:07
96
88
94
99
33
4:39:55 PM
4:39:56 PM
00:00:01
95
92
92
93
34
4:40:12 PM
4:40:28 PM
00:00:16
96
83
73
92
35
4:41:07 PM
4:41:57 PM
00:00:50
98
90
86
93
36
4:42:20 PM
4:42:27 PM
00:00:07
94
90
93
93
37
4:42:34 PM
4:42:37 PM
00:00:03
95
90
93
93
38
4:42:41 PM
4:42:46 PM
00:00:05
93
90
90
92
39
4:42:54 PM
4:43:04 PM
00:00:10
96
88
89
92
40
4:43:13 PM
4:43:15 PM
00:00:02
93
90
91
91
41
4:43:19 PM
4:43:29 PM
00:00:10
94
89
93
108
42
4:44:21 PM
4:44:23 PM
00:00:02
95
92
91
91
43
4:44:51 PM
4:44:55 PM
00:00:04
97
90
93
96
44
4:45:04 PM
4:45:05 PM
00:00:01
95
89
81
90
45
4:45:19 PM
4:45:25 PM
00:00:06
96
93
100
112
46
4:46:01 PM
4:46:04 PM
00:00:03
96
92
94
111
47
4:47:31 PM
4:47:33 PM
00:00:02
97
91
103
110
48
4:47:50 PM
4:47:54 PM
00:00:04
96
90
107
117
49
4:48:07 PM
4:48:13 PM
00:00:06
96
85
87
111
50
4:49:00 PM
4:49:18 PM
00:00:18
97
84
84
109
51
4:49:54 PM
4:50:05 PM
00:00:11
88
84
100
136
52
4:50:34 PM
4:50:44 PM
00:00:10
92
80
36
136
53
4:53:05 PM
4:54:58 PM
00:01:53
97
92
100
115
54
4:55:29 PM
4:55:32 PM
00:00:03
96
86
111
111
55
4:56:17 PM
4:56:30 PM
00:00:13
96
93
95
111
56
4:56:36 PM
4:56:45 PM
00:00:09
98
92
96
96
57
4:56:51 PM
4:56:55 PM
00:00:04
96
92
97
97
58
4:56:58 PM
4:57:12 PM
00:00:14
95
90
97
98
59
4:57:24 PM
4:57:33 PM
00:00:09
95
90
73
97
60
4:57:36 PM
4:57:52 PM
00:00:16
96
90
97
107
61
4:58:31 PM
4:58:42 PM
00:00:11
95
92
98
100
62
4:58:43 PM
4:58:45 PM
00:00:02
96
91
98
99
63
4:59:15 PM
4:59:24 PM
00:00:09
97
88
95
95
64
4:59:43 PM
4:59:45 PM
00:00:02
98
94
99
99
65
4:59:52 PM
5:00:01 PM
00:00:09
99
95
61
99
66
5:00:06 PM
5:00:20 PM
00:00:14
99
92
61
100
67
5:00:29 PM
5:00:33 PM
00:00:04
97
90
99
99
68
5:00:53 PM
5:01:07 PM
00:00:14
97
93
72
99
VirtuOx, Inc.
Private and Confidential
Page 4 of 8
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
ID
Start
End
Duration
SpO2 onset
SpO2 Low
Overnight Room Air
Pulse Low
Pulse High
69
5:01:23 PM
5:01:55 PM
00:00:32
99
92
89
100
70
5:02:08 PM
5:02:24 PM
00:00:16
95
85
99
99
71
5:02:29 PM
5:02:33 PM
00:00:04
97
93
99
99
72
5:02:45 PM
5:02:48 PM
00:00:03
96
84
100
100
73
5:03:08 PM
5:03:34 PM
00:00:26
98
92
94
100
74
5:03:43 PM
5:03:45 PM
00:00:02
96
90
94
98
75
5:04:03 PM
5:04:42 PM
00:00:39
96
93
89
97
76
5:04:43 PM
5:04:51 PM
00:00:08
97
92
95
96
77
5:04:53 PM
5:04:55 PM
00:00:02
95
91
94
94
78
5:05:06 PM
5:05:19 PM
00:00:13
95
89
90
100
79
5:05:45 PM
5:06:10 PM
00:00:25
96
91
93
102
80
5:06:13 PM
5:06:21 PM
00:00:08
94
91
93
94
81
5:06:48 PM
5:06:59 PM
00:00:11
94
80
94
95
82
5:07:13 PM
5:07:22 PM
00:00:09
95
90
94
94
83
5:07:29 PM
5:07:37 PM
00:00:08
96
90
93
95
84
5:07:44 PM
5:07:48 PM
00:00:04
94
85
95
95
85
5:08:20 PM
5:09:04 PM
00:00:44
96
83
94
98
86
5:09:59 PM
5:10:01 PM
00:00:02
94
89
110
110
87
5:10:20 PM
5:10:30 PM
00:00:10
95
92
100
107
88
5:10:46 PM
5:11:01 PM
00:00:15
95
85
97
109
89
5:11:11 PM
5:11:13 PM
00:00:02
92
88
113
116
90
5:11:55 PM
5:11:57 PM
00:00:02
94
90
119
119
91
5:12:07 PM
5:12:19 PM
00:00:12
93
85
114
117
92
5:13:24 PM
5:14:37 PM
00:01:13
93
90
101
124
93
5:14:48 PM
5:15:12 PM
00:00:24
94
90
107
115
94
5:15:21 PM
5:15:37 PM
00:00:16
94
90
97
111
95
5:15:39 PM
5:15:48 PM
00:00:09
94
82
97
97
96
5:15:58 PM
5:16:00 PM
00:00:02
92
89
97
102
97
5:16:02 PM
5:16:03 PM
00:00:01
92
86
102
102
98
5:16:11 PM
5:16:17 PM
00:00:06
93
87
102
105
99
5:16:32 PM
5:16:38 PM
00:00:06
97
91
94
105
100
5:16:46 PM
5:17:21 PM
00:00:35
97
93
100
115
101
5:17:23 PM
5:17:26 PM
00:00:03
96
93
108
108
102
5:17:40 PM
5:17:43 PM
00:00:03
96
89
114
115
103
5:18:10 PM
5:19:21 PM
00:01:11
96
92
99
117
104
5:21:06 PM
5:21:29 PM
00:00:23
96
93
102
104
105
5:21:31 PM
5:21:34 PM
00:00:03
96
89
103
103
106
5:21:44 PM
5:21:49 PM
00:00:05
96
93
90
90
VirtuOx, Inc.
Private and Confidential
Page 5 of 8
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
ID
Start
End
Duration
SpO2 onset
SpO2 Low
Overnight Room Air
Pulse Low
Pulse High
107
5:21:53 PM
5:21:57 PM
00:00:04
96
91
97
99
108
5:22:36 PM
5:22:44 PM
00:00:08
95
91
101
104
109
5:23:04 PM
5:23:19 PM
00:00:15
94
90
98
101
110
5:23:38 PM
5:23:42 PM
00:00:04
97
94
97
98
111
5:23:50 PM
5:23:53 PM
00:00:03
98
90
97
99
VirtuOx, Inc.
Private and Confidential
Page 6 of 8
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
Overnight Room Air
SPO2 % Times Graph
VirtuOx, Inc.
Private and Confidential
Page 7 of 8
Patient Name: miko, kyle
Physician Name: Brady, Tom
Test Time: 10/27/2011 4:23:45 PM To 10/27/2011 5:24:14 PM
Test Condition:
Overnight Room Air
SPO2 % Times Chart
SPO2: 99
0.2 % time
SPO2: 89
1.5 % time
SPO2: 79
0.0 % time
SPO2: 98
1.7 % time
SPO2: 88
1.4 % time
SPO2: 78
0.0 % time
SPO2: 97
4.6 % time
SPO2: 87
0.8 % time
SPO2: 77
0.0 % time
SPO2: 96
9.1 % time
SPO2: 86
1.1 % time
SPO2: 76
0.0 % time
SPO2: 95
18.6 % time
SPO2: 85
0.7 % time
SPO2: 75
0.0 % time
SPO2: 94
19.5 % time
SPO2: 84
0.2 % time
SPO2: 74
0.0 % time
SPO2: 93
20.7 % time
SPO2: 83
0.2 % time
SPO2: 73
0.0 % time
SPO2: 92
9.6 % time
SPO2: 82
0.1 % time
SPO2: 72
0.0 % time
SPO2: 91
5.9 % time
SPO2: 81
0.1 % time
SPO2: 71
0.0 % time
SPO2: 90
3.8 % time
SPO2: 80
0.2 % time
SPO2: 70
0.0 % time
Total 90's
93.7 % time
Total 80's
6.3 % time
Total 70's
0.0 % time
SPO2: 69
0.0 % time
SPO2: 59
0.0 % time
SPO2: 49
0.0 % time
SPO2: 68
0.0 % time
SPO2: 58
0.0 % time
SPO2: 48
0.0 % time
SPO2: 67
0.0 % time
SPO2: 57
0.0 % time
SPO2: 47
0.0 % time
SPO2: 66
0.0 % time
SPO2: 56
0.0 % time
SPO2: 46
0.0 % time
SPO2: 65
0.0 % time
SPO2: 55
0.0 % time
SPO2: 45
0.0 % time
SPO2: 64
0.0 % time
SPO2: 54
0.0 % time
SPO2: 44
0.0 % time
SPO2: 63
0.0 % time
SPO2: 53
0.0 % time
SPO2: 43
0.0 % time
SPO2: 62
0.0 % time
SPO2: 52
0.0 % time
SPO2: 42
0.0 % time
SPO2: 61
0.0 % time
SPO2: 51
0.0 % time
SPO2: 41
0.0 % time
SPO2: 60
0.0 % time
SPO2: 50
0.0 % time
SPO2: 40
0.0 % time
Total 60's
0.0 % time
Total 50's
0.0 % time
Total 40's
0.0 % time
VirtuOx, Inc.
Private and Confidential
Page 8 of 8