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MELT/MET 95805 Worksheet
PH#: 8885110401Website: www.eviCore.comPatientPatient Name:
DOB:
Insurance Plan:Member ID:Epworth Sleepiness Score (ESS, see page 3):
Height:Physician BMI:
Ordering Physician
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How to fill out epworth sleepiness scale and
How to fill out epworth sleepiness scale and
01
To fill out the Epworth Sleepiness Scale, follow these steps:
1. Rate your chance of dozing off or falling asleep in eight different situations on a scale of 0 to 3.
2. Each situation describes your typical daytime sleepiness levels, so assess how likely you are to fall asleep during these activities.
3. Add up the scores for each situation to obtain a total score.
4. The higher the total score, the higher the daytime sleepiness levels.
Here are the situations you will rate:
1. Sitting and reading
2. Watching TV
3. Sitting inactive in a public place
4. Being a passenger in a motor vehicle for an hour
5. Lying down to rest in the afternoon when circumstances permit
6. Sitting and talking to someone
7. Sitting quietly after a lunch without alcohol
8. In a car, while stopped for a few minutes in traffic
Who needs epworth sleepiness scale and?
01
The Epworth Sleepiness Scale is useful for anyone who wants to assess their daytime sleepiness levels. It is commonly used by healthcare professionals, sleep specialists, and researchers to evaluate the severity of sleep disorders, such as obstructive sleep apnea, narcolepsy, and excessive daytime sleepiness. It can also be helpful for individuals who want to monitor their sleep patterns and determine if they require further evaluation or treatment for sleep-related problems.
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What is epworth sleepiness scale and?
Epworth Sleepiness Scale is a questionnaire used to assess an individual's level of daytime sleepiness.
Who is required to file epworth sleepiness scale and?
The Epworth Sleepiness Scale is typically filled out by individuals who are experiencing excessive daytime sleepiness.
How to fill out epworth sleepiness scale and?
To fill out the Epworth Sleepiness Scale, an individual rates their likelihood of falling asleep in various situations on a scale from 0 to 3.
What is the purpose of epworth sleepiness scale and?
The purpose of the Epworth Sleepiness Scale is to help determine if an individual may be suffering from a sleep disorder or excessive daytime sleepiness.
What information must be reported on epworth sleepiness scale and?
The Epworth Sleepiness Scale requires individuals to report their likelihood of falling asleep in specific situations and activities.
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