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Click ‘Get Form’ to open the SLEEP STUDY REQUISITION in the editor.
Begin by entering the patient's name and date of birth (D.O.B) in the designated fields. Ensure accuracy for proper identification.
Select the patient's gender by checking either 'Male' or 'Female'.
Fill in the contact details, including telephone numbers and mailing address, ensuring all information is current.
Indicate the referring physician's name and billing number, which are essential for processing.
Choose the reason for referral by ticking one of the options: Sleep Study only, Consultation only, or both.
Answer mandatory questions regarding CPAP/BIPAP usage and home oxygen needs by circling 'YES' or 'NO'.
If applicable, indicate any special patient needs such as ambulance or wheelchair assistance.
Complete the patient history section by checking relevant medical conditions.
Finally, have the referring physician sign and date the form before submission.

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