ONeal Medical-CPAP Plus

In Partnership with Magic City Sleep, LLC

In-Store Home Sleep Test (HST) Referral, Payment, and Data Collection Procedure

Purpose:

To provide a seamless in-store process for patients to request a Home Sleep Test (HST), select an appropriate device, complete payment, and provide key sleep-related demographic information.

ONeal Medical-CPAP Plus staff will collect intake and sleep-specific data and securely transfer it to Magic City Sleep, LLC, who will handle test administration, interpretation, and reporting.

1. Patient Walk-In Process

• Patients may walk into any ONeal Medical-CPAP Plus location and request a Home Sleep Test (HST).

• ONeal staff will explain:

  • The HST will be performed and interpreted by Magic City Sleep, LLC.

  • The test is self-pay only (no insurance billing).

  • Payment is to be made at the time of visit using a QR code linked to Magic City Sleep’s payment portal.

  • ONeal Medical-CPAP Plus is only assisting with intake and device facilitation — Magic City Sleep, LLC is the provider of the test.

2. Patient Intake, Consent, and Sleep-Specific Data

• The patient will complete and sign an HST Consent & Acknowledgment Form, which:

  • Authorizes sharing of patient information with Magic City Sleep, LLC.

  • Acknowledges that payment is self-pay and paid to Magic City Sleep.

  • Clarifies that Magic City Sleep is the provider of record for this test.

• Staff will complete an HST Intake & Sleep-Specific Data Form that includes:

  • Demographics:

    • Patient Name

    • Date of Birth

    • Address

    • Phone Number

    • Email Address

    • Primary Care Provider (if known)

    • Referring Provider (if applicable)

  • Sleep-Specific Data:

    • Epworth Sleepiness Scale Score

    • Height / Weight / BMI

    • Neck Circumference

    • Blood Pressure (if known or measured)

    • Relevant comorbidities (HTN, diabetes, heart disease, etc.)

    • Previous sleep testing history (if any)

    • Sleep symptoms (snoring, gasping, witnessed apnea, daytime fatigue, etc.)

    • Reason for sleep study (referral, personal interest, suspected apnea, etc.)

• The specific data fields collected will match Magic City Sleep, LLC’s specifications and any required clinical fields they designate.

3. Device Selection and Payment

• Staff will assist patient in selecting the appropriate HST device per Magic City Sleep’s offerings.

• Provide any relevant literature or device instructions.

• Provide Magic City Sleep’s QR code for payment.

  • The patient completes payment on their phone via the QR code and payment portal.

  • Staff verifies payment was successfully completed and notes payment on intake form (“PAID”).

4. Information Transfer

• Once payment is verified:

  • The completed HST Intake & Sleep-Specific Data Form and signed Consent Form are securely sent to Magic City Sleep, LLC using:

    • Secure HIPAA-compliant email,

    • Secure shared portal, or

    • Fax (per Magic City Sleep’s preference).

• Magic City Sleep, LLC will:

  • Arrange shipment or pick-up of the HST device.

  • Provide test instructions.

  • Interpret results and report back to the patient and referring provider (if applicable).

5. Tracking & Follow-Up

• Staff maintains an HST Referral Log to track:

  • Patient Name

  • Date of Referral

  • Device selected

  • Sleep-specific data collected

  • Payment status (Paid)

  • Date info sent to Magic City Sleep

  • Test result received (optional, for patient care continuity)

6. Staff Training

All ONeal Medical-CPAP Plus front-line staff will be trained on:

• Process flow

• How to present and explain the program to patients

• How to assist with QR code payment

• How to properly collect required intake and sleep-specific data

• How to securely handle and transfer information per HIPAA compliance

7. Forms TBA - PDFs will be linked below.

✅ HST Consent & Acknowledgment Form

✅ HST Intake & Sleep-Specific Data Form (including Epworth, BMI, etc.)

✅ Referral Log (Excel)

✅ Staff Training Checklist