Online Referrals for GPS

Bulk Billing is Available for Sleep Studies and Respiratory Function Tests

Sleep Study
* Please complete the ESS and STOP-BANG questionnaires. Only patients with ESS ≥ 8 and STOP - BANG score ≥ 4 qualify for a direct referral as per the Medicare requirements.
Respiratory Function Tests

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EPWORTH SLEEPINESS SCALE (ESS)

Use the scale on the right to choose the most
appropriate number for each situation
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

SITUATION

CHANCE OF DOZING (0 - 3)

Sitting and reading
-
+
Watching TV
-
+
Sitting, inactive in a public place (e.g. a theatre or a meeting)
-
+
As a passenger in a car for an hour without a break
-
+
Lying down to rest in the afternoon when circumstances
permit
-
+
Sitting and talking to someone
-
+
Sitting quietly after a lunch without alcohol
-
+
In a car, while stopped for a few minutes in the traffic
-
+
Write down total score

STOP-BANG QUESTIONNAIRE

Do you SNORE loudly?
Do you often feel TIRED, fatigued, or sleepy during the daytime?
Has anyone OBSERVED you stop breathing or choke or gasp for air
during your sleep?
Do you have or are you being treated for high blood PRESSURE?
BMI more than 35 kg per m2?
Age over 50 years old?
Neck circumference >40 cm?
Gender: Male?
Write down total YES score
Submit

PLEASE AVOID THE FOLLOWING PRIOR TO TESTING:

(Scroll to right to see more)
TIME TO AVOID PRIOR TO TEST
Medication Class Generic Name Respiratory Function Testing Bronchial Provocation Testing
SABA Ventolin, Bricanyl, Atrovent, Asmol 6 hours 8 hours
ICS Alvesco, Flixotide, Pulmicort, Qvar, Arnuity 24 hours 24 hours
LAMA Spiriva, Bretaris, Seebri, Incruse 12 hours 24 hours
LABA Serevent, Foradile,Oxis, Onbrez 24 hours 24 hours
LAMA/LABA Spiolto, Ultibro, Brimica, Anoro 24 hours 24 hours
LABA/ICS Seretide, Symbicort, Flutiform, Breo 24 hours 24 hours
LAMA/LABA/ICS Trelegy 24 hours 24 hours
Theophylline Nuelin, Theodur NA 24 hours
Antihistamine Zyrtec, Telfast, Claratyne NA 72 hours
Caffeine Coffee, tea, soft drinks, energy drinks NA Day of Test

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