Online Referrals for GPS

Bulk Billing is Available for Sleep Studies and Respiratory Function Tests

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Sleep Study
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* 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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Requesting Doctor

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

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