PAP Therapy Follow-Up Note (Medicare/DME Compliance & Benefit)

Date of Service: [date]

Treating Practitioner: [name, credentials]

Visit Modality: [in-person / telehealth] (If telehealth, include patient location and consent.)

Coverage Context: [Initial trial (Day 31–91 compliance visit) / Post-trial continuation or resupply / Device replacement / Beneficiary new to Medicare on existing PAP / Re-qualification after failed trial]

PAP Initiation Date: [date] (If unavailable, state "data unavailable — plan to obtain from DME/patient by [date].")

Device/Supplier: [device type; DME supplier if known]

History

[Chief complaint in one sentence]

[Patient-reported PAP use pattern including nights per week, typical hours per night, and barriers to use]

[Symptom response comparing baseline to current status for sleepiness, snoring, witnessed apneas, morning headaches, and sleep quality] (Include at least one concrete functional benefit statement when present; patient quotes are helpful.)

[Side effects and patient-initiated troubleshooting] (Document mask issues, dryness, aerophagia, insomnia; note adjustments already tried.)

[Clinically significant interval changes] (Include only if relevant: weight change, nasal symptoms, cardiopulmonary status.)

Objective

Vitals: [weight, BMI, BP as relevant]

PAP Download Data:

• Report source: [cloud portal / SD card / printed report] reviewed [review date] (If unavailable, state "No download available — plan to obtain from [source] by [date].")
• Date range: [start] to [end] (Use a consecutive 30-day period for initial trial adherence evaluation.)
• Usage: [% nights used], [% nights ≥4 hours], [average hours on nights used]
• Leak: [metric as reported] (If not available, state "not reported by device.")
• Residual AHI: [value]

Adherence Interpretation: [meets / does not meet / unable to determine] Medicare definition for initial trial (≥4 hours on ≥70% of nights within a consecutive 30-day period). (Include supporting figures and date range. If data unavailable, state plan to obtain.)

Assessment

OSA on PAP: [Current clinical status and symptom trajectory] [Objective adherence status summarizing download metrics] [Efficacy assessment interpreting residual AHI and leak; note treatment-emergent centrals or persistent events if present]

[Secondary problem]: [Assessment] (Include only if present: mask intolerance, residual excessive sleepiness, insomnia, nasal obstruction, aerophagia, treatment-emergent centrals.)

Plan

• Continuation/Change: [continue current PAP / adjust pressures or modes / change mask/interface / consider alternative therapy] (Provide rationale linked to adherence, efficacy, side effects, and patient preference.)
• Settings or interface changes made today: [specific changes with rationale]
• Troubleshooting performed: [education and actions taken]
• Supplies needed with justification: [items and quantities with patient-specific reasons] (Avoid generic "routine replacement" language.)
• Referrals/Orders: [orders placed or referrals made]
• Ongoing need statement: [brief justification for continued coverage based on documented benefit, adherence, and persistent OSA diagnosis]

Medicare Compliance Attestation (Include for initial trial Day 31–91 visits only):

• PAP initiation date: [date]
• Clinical re-evaluation date: [today's date]
• Symptoms improved: [yes / no] — [brief supporting detail]
• Objective adherence reviewed by treating practitioner: [yes / no]
• Adherence criteria met: [yes / no / unable to determine] — [qualifying metric and date range]
• Continued coverage medically necessary: [yes / no]

(Each determination must be encounter-specific; do not carry forward from prior visits.)

If adherence requirements not met:

• Reasons for nonadherence: [mask intolerance, nasal obstruction, insomnia, device issues, etc.]
• Intensive troubleshooting performed: [actions and counseling]
• Remediation plan: [steps, responsible party, and timeline for repeat download and reassessment]

Follow-up

[Timing and monitoring plan specifying when/how next download will be reviewed and return visit interval]