SLEEP CENTER REFERRAL FORM - National Jewish Health - nationaljewish 2026

1. Click ‘Get Form’ to open the SLEEP CENTER REFERRAL FORM in the editor.
2. Begin by filling out the PATIENT INFORMATION section. Enter the patient's last name, first name, date of birth (DOB), and social security number (SS#). Ensure you provide accurate contact details including street address, city, state, zip code, and phone numbers.
3. In the PRIMARY INSURANCE section, input the insurance details such as ID#, group number, and guarantor information. Make sure to include the subscriber's DOB and employer for completeness.
4. Indicate the reason for referral by checking all applicable options under 'THIS PATIENT IS BEING REFERRED FOR'. This includes consultations and various sleep study types.
5. Check any SUSPECTED DISORDERS and Relevant Medical History that apply. This helps in providing a comprehensive overview of the patient's condition.
6. Complete the Primary Care Physician and Referring Physician sections with their contact information. Don’t forget to sign and date the form before submission.
7. Finally, complete the Epworth Sleepiness Scale on the back side of the page. Once finished, fax both sides of the sheet to 303-270-2109.

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