Images of a sleep study referral form 2026

1. Click ‘Get Form’ to open the sleep study referral form in the editor.
2. Begin by filling out the 'Referring Physician' section. Enter your name, address, phone number, zip code, and fax number accurately.
3. Next, move to the 'Patient Information' section. Input the patient's name, date of birth (DOB), address, city/state, home and work phone numbers, height, weight, gender (M/F), occupation, and social security number (SSN).
4. Complete the 'History & Physical Information' section. Indicate any relevant symptoms such as witnessed apnea or daytime fatigue by checking the appropriate boxes.
5. In the 'Medical Conditions' area, mark any existing conditions that apply to the patient. This includes GERD, diabetes, or chronic pain.
6. Fill in the 'Medications' section if oxygen is required. Specify the liters per minute (l/m) needed.
7. Proceed to complete the 'Physical Exam' details including HEENT findings and neurologic exam results.
8. In 'Diagnosis Suspected', select any applicable diagnoses such as obstructive sleep apnea or narcolepsy.
9. Finally, indicate the tests requested by checking off options like Polysomnogram or CPAP titration.
10. Ensure you sign at the bottom as the referring physician and include any necessary medical director information before submitting.

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