Sleep Study Order Form - UF Health Jacksonville 2026

1. Click ‘Get Form’ to open the Sleep Study Order Form in the editor.
2. Begin by filling out the Patient Demographics section. Enter the date, MRN, SS#, and DOB accurately. Provide the patient's name, height, weight, and address details including city, state, and zip code.
3. Next, input contact information: home phone, work phone, and cell phone. If applicable, include the parent or guardian's name.
4. Complete the insurance information by entering primary and secondary insurance details along with the guarantor's name and authorization numbers.
5. In the Diagnosis Code section, check the appropriate box that corresponds to the presenting diagnosis. Ensure you select only one option.
6. Circle any relevant medical alerts that apply to the patient for better care management.
7. Select desired services from Interpreting Sleep Physicians by checking either 'Interpretation, evaluation & follow up' or 'Interpretation ONLY'.
8. Finally, have the ordering physician print their complete name and provide their signature along with date and time before submitting.

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