Survey of users of
Portable Oxygen Concentrator (POC) regarding
oxygenation issues associated with their use.
If you have used more
than one POCs then please complete one survey for each
unit.
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1. Have you used a
POC? |
Yes
No, If No,
survey complete. Thank you for your interest! |
|
2. How did you acquire
your POC? |
Purchased from whom?
Rent the unit |
A home care dealer
An oxygen distributor
A web site
Other:
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3. What system did/do
you use? |
Sequal Eclipse
Respironic EverGo
Inogen One
Airsep LifeStyle
Airsep FreeStyle
Other:
If you have used more than one system, please repeat
this survey for the second, third, etc. units you have
used. |
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4. Have you ever
changed to another system? |
YES, explain
NO |
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5. What was your
resting oxygen setting when using the POC? |
|
1
2
3
4
5
6
|
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6. Did you use a
different setting for sleep or exercise? |
YES, If Yes,
what setting for sleep
1
2
3
4
5
6
what setting for exercise (activity.motion)
1
2
3
4
5
6
NO |
|
7. What portable
system do you use when not using a POC? |
Liquid Oxygen
Compressed Gas
Other:
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8. Who helped you
determine the oxygen settings for your POC? |
Doctor
Respiratory Therapist
Physician's Assistant
RN
Other:
|
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9. Do you have an
oximeter? |
YES, If Yes, do you change the settings on your POC
based on your oximeter reading?
YES
NO
NO |
|
10. Do you use your
POC while sleeping? |
YES
NO |
|
11. Do you take
commercial airline flights with your POC? |
YES
If YES, I have been denied use of my POC on a commercial
airline flight!
Airline?
If YES, I have been charged extra by a commerical
airline because of my POC! Airline?
NO |
|
12. Have you had a
problem with your POC? |
YES, explain
NO |
|
13. If you had a
problem, who helped you solve the problem? |
Doctor
Respiratory Therapist
Physician's Assistant
RN
Home
care provider
Manufacturer
If the problem has not been resolved, please explain the
issue(s):
|
|
14. Do you feel you
receive enough oxygen with the
POC? |
YES
NO, if NO
please explain:
|
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15. Was the POC easy
to understand and operate? |
YES
NO, if NO
please explain:
|
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16. Will you continue
to use a
POC? |
YES
NO, if NO
please explain why:
|
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17. Would you
recommend the use of a
POC? |
YES
NO, if NO
please explain why:
|
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18. What medical
condition have you been diagnosed with that requires
Long Term Oxygen Treatment (LTOT)? |
Emphysema/COPD
Lung Cancer
Pulmonary Hypertension (PH)
Bronchiectasis
Idiopathic Pulmonary Fibrosis
(IPF)
Other:
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19. What is your age? |
|
Years |
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20. What is your
gender? |
MALE
FEMALE |
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21 . What country and
state of province do you live in? |
WHAT COUNTRY DO YOU LIVE IN?
WHAT STATE OR PROVINCE?
USA two letter
designation, e.g. CA, CO, FL, MN, etc.
Other countries, Three
letter designation, e.g. ONT (for Ontario, Canada) |
If you have any questions or need and help regarding
this survey, please contact
lolson@ltotnet.org
Thank you for
your participation! The findings will be published on
the
www.LTOTnet.org web
site at a later date.
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