Get Apria Sleep Therapy Order Form

Filling out the Apria Sleep Therapy Order Form online can seem daunting, but with this guide, you will easily navigate through each section of the form. This comprehensive walkthrough provides clear, step-by-step instructions to ensure you complete the form accurately.

Follow the steps to fill out the Apria Sleep Therapy Order Form online.

1. Click the ‘Get Form’ button to obtain the Apria Sleep Therapy Order Form and open it in your preferred editor.
2. Begin by filling in your Apria representative's name and branch location in the designated fields. Ensure that the contact phone number is also included to facilitate any needed follow-up.
3. In the referral source section, you should fill in the office name, contact person's name, phone number, fax number, and the date. Make sure all contact information is accurate.
4. For patient information, enter the patient's name, home phone number, and mobile phone number. Also, include the patient’s date of birth and diagnosis using the provided ICD-9 codes, and specify any additional conditions as needed.
5. Complete the oxygen requirement section, indicating the estimated length of need and relevant testing details, including location and applicable SpO2 results. Be sure to report qualifying saturation test results as required.
6. Select the needed oxygen conserving device from the options given. Specify the setting and note that titration should aim for a SpO2 of ≥ 90%. Include any pertinent overnight oximetry testing results.
7. For nebulizer information, indicate the required medication, frequency, and dosage. Ensure that you also include the required documentation of need from the patient's chart.
8. In the sleep therapy section, specify the estimated length of need and the date for the re-evaluation appointment. Fill out the necessary measurements for CPAP or Bi-level settings, and let the patient choose their preferred mask type.
9. At the end of the form, the prescriber must sign and date the document, confirming the use of the order form as a dispensing prescription. Ensure that the prescriber's name and NPI number are clearly printed.
10. Once you have filled out all sections of the form, review the information for accuracy. You can then save your changes, download or print the form, or share it as necessary.

Start completing the Apria Sleep Therapy Order Form online now!