Get Referral Form - Fusion Sleep

Filling out the referral form for Fusion Sleep is an important step in seeking help for sleep-related concerns. This guide will provide you with detailed instructions on how to complete the form efficiently and accurately.

Follow the steps to complete the referral form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your online document editor.
2. Fill out the office contact details section with the office name, phone number, and fax number. Ensure these details are accurate for effective communication.
3. Provide the patient’s personal information. Enter the last name, first name, gender, and phone numbers. Be sure to indicate the best number for contacting the patient.
4. Input the patient’s date of birth (DOB) and indicate whether you may leave a message on their voicemail or answering machine by selecting YES or NO.
5. Complete the Epworth Sleepiness Scale. For each situation listed, circle the corresponding number that reflects how likely the patient is to doze off in that scenario.
6. Check all applicable conditions from the list of symptoms that pertain to the patient’s sleep experience, such as snoring or waking gasping for air.
7. Have the provider complete their section by entering the height, weight, and blood pressure (B/P). Refer to the office notes for additional details as necessary.
8. Detail the patient’s medical history, including any known conditions like hypertension or diabetes, along with a list of current medications and allergies.
9. List any presenting symptoms the patient is experiencing, marking those that apply from the provided options.
10. In the provider order section, select the appropriate consultation type desired for the patient. The provider should then print their name and provide their signature.
11. Add any additional comments and notes in the comments section if necessary, ensuring it is fine-tuned to the patient's needs.
12. Once all sections are filled out, save changes, and choose to download, print, or share the completed referral form as needed.

Complete the referral form online today to take the first step towards improved sleep health.