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Click ‘Get Form’ to open the Home Sleep Study Order Form in the editor.
Begin by filling out the Prescriber Information section. Enter the physician's name, practice name, type, address, city, state, phone, fax, NPI#, primary contact, and email.
Next, complete the Patient Information section. Input the patient's name (last and first), address, city, primary and alternate phone numbers, sex, state, zip code, date of birth (DOB), email address, and patient ID#.
In the Sleep History & Physical section, select at least one symptom that applies to the patient’s sleep issues by checking the appropriate boxes.
Proceed to fill in the Diagnosis (ICD-9) section by selecting any applicable diagnoses related to sleep apnea or other conditions.
Indicate the Diagnostic Service Ordered by selecting either 'Home Sleep Test' and specify if it is for 1 or 2 nights. Remember to request a therapy prescription form if needed.
Finally, ensure that you sign and date the form in the designated areas before submitting it via fax as instructed.
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Your doctor needs to prescribe it. This isnt an over-the-counter test. Your primary care physician or a physician at a sleep clinic can order it for you to use at home.
Do I need a prescription for an at-home sleep study?
How much do home sleep studies cost? The cost of most home sleep apnea testing in the U.S. falls between $150 to $500. Often, health insurance covers some or all of the cost. You may need to pay the insurance deductible if you have not already.
How much does an at home sleep study cost?
If you opt for an overnight study at a sleep center, expect to pay anywhere from $500 to $3,000 for your stay. At-home sleep tests are much more affordable by comparison. Our test costs $189 and includes a virtual consultation with a board-certified sleep specialist to make sure you are a candidate for a sleep study.
Can I refer myself for a sleep study?
For Patients To schedule a sleep study, you will need a referral from a physician and in some cases an authorization from your health insurance company.
How to schedule a home sleep study?
Schedule a visit with a care provider. A prescription is required to get a home sleep test, so if youre experiencing symptoms of OSA, youll need to make an appointment with your provider. Many home sleep test companies offer virtual consultations for this purpose as well.
virtuox home sleep study form
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