STOP - BANG - stmarysmaine.com 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the STOP section. Answer each question by selecting 'YES' or 'NO'. Ensure you provide honest responses, as these will help assess your risk for Obstructive Sleep Apnea.
3. Move on to the BANG section. Again, respond to each question with 'YES' or 'NO'. Pay special attention to the BMI question and refer to the included chart if needed.
4. If you answered 'YES' to three or more questions, complete the patient information section at the bottom. Fill in your name, date of birth, phone number, weight, and height accurately.
5. For healthcare providers filling out the Physician Order Request, ensure all relevant details are filled in, including physician's name and contact information.

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