Follow the steps to complete your requisition form accurately.

1. Press the ‘Get Form’ button to access the Sleep Study Requisition form and open it in your preferred editor.
2. Enter the patient's name in the designated field clearly to ensure proper identification.
3. Provide the date of birth in the format d/m/y, ensuring it is correct to avoid any delays.
4. Select the appropriate gender by ticking the box next to ‘Male’ or ‘Female’ as applicable.
5. Fill in the telephone number for the patient's home and business, ensuring they can be reached if necessary.
6. Input the patient's medical record number (MRN) for reference.
7. Complete the patient's mailing address to ensure proper delivery of information.
8. Enter the OHIP number appropriately.
9. For the referring physician, fill in the name and any relevant billing number.
10. Tick the reason for referral as either 'Sleep Study only', 'Consultation only', or 'Sleep Study & Consultation'.
11. Indicate whether the referral is diagnostic or therapeutic by selecting the appropriate option.
12. Circle 'YES' or 'NO' to indicate if the patient is on CPAP or BIPAP.
13. Circle 'YES' or 'NO' to indicate if the patient is using home oxygen, and specify the liters per minute if applicable.
14. If applicable, indicate whether the patient has had a previous sleep study by circling 'YES' or 'NO', and provide the date of the previous study.
15. List any special patient needs, such as ambulance, wheelchair, or requiring an attendant, if relevant.
16. Mark any pertinent medical history regarding chronic heart failure, heart disease, pulmonary disease, renal disease, hypertension, diabetes, neurological disease, obesity, or obstructive sleep apnea.
17. Finally, the referring physician must sign the form and include the date to validate the request.
18. Once all fields are completed, save your changes, and you may download, print, or share the form as needed.

Begin filling out your sleep study requisition form online today.