Patient name:

Parent/Legal Guardian name:

Date:

 

To complete a Paediatric Sleep Study with Video, we require your written consent to use video and sound recordings. The video camera links to the sleep study device which allows synchronised body movement recording, as well as audio recording of snoring.

 

The recording will happen in the bedroom (or any other room that the patient uses to sleep overnight) at the patient’s address and is intended to record the patient while sleeping.

 

The recording will be used for the sole purpose of clinical assessment by the clinical team and parts of the video might need to be shared with consultants when requested. This is clinically useful to improve the quality of the study and helps clinicians make a better decision. When nasal cannulas are not tolerated, the information recorded on video is crucial to support the diagnosis. The recordings will be kept securely in line with the Data Protection Act 1998. 

 

Recordings will be kept for a period of three months after which they will be deleted from our systems.

If you would like them deleted sooner, please inform S-Med Ltd. 

 

 

 

Parent/ Legal Guardian Signature

 

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