Get Home Sleep Test (hst) Order Form: Submit Via Fax To: 1-866-216-5200

Filling out the Home Sleep Test (HST) Order Form accurately is essential for ensuring a smooth testing process for patients. This guide will provide you with step-by-step instructions for completing the form, helping you navigate each section with confidence.

Follow the steps to complete the HOME SLEEP TEST (HST) ORDER FORM effectively.

1. Press the ‘Get Form’ button to access the form and open it in your document editor.
2. Fill in the prescriber information. This includes the ordering provider's name, phone number, fax number, National Provider Identifier (NPI), and office contact name with their phone number if applicable.
3. Provide the patient information, including the first name, last name, date of birth (in mm/dd/yyyy format), gender, height, weight, state, zip code, address (be sure to include the apartment number if applicable), city, primary phone number, alternate phone number, and preferred language if it is not English.
4. In the payment/insurance section, select whether the patient requests self-payment or insurance billing. If choosing self-payment, note the option for three credit card installments. If using insurance, attach a copy of the insurance card and complete the relevant fields.
5. Complete the diagnosis/medical history/symptoms section. Note the appropriate ICD-9 code, identify at least two symptoms from the list provided, and attach any required medical documentation.
6. Select the appropriate test type based on the patient's needs, indicating whether a Home Sleep Test only or a Titration Test is required.
7. For the designated therapy/durable medical equipment provider section, provide the name, phone number, and fax number as necessary. Ensure that this is completed for results to be sent correctly.
8. Finally, the ordering provider must sign and date the form to validate it. Remember that stamped signatures are not accepted.
9. Once all fields are completed, you can save the changes to your document, download, print, or share the form as needed.

Complete the HOME SLEEP TEST (HST) ORDER FORM online to ensure fast and efficient processing for your patients.