Get Referral For Diagnostic Sleep Testing

Filling out the referral for diagnostic sleep testing can seem complex, but with the right guidance, you'll navigate it smoothly. This comprehensive guide will walk you through each component of the form to ensure you provide all necessary information accurately.

Follow the steps to complete your referral form without difficulties.

1. Click 'Get Form' button to access the referral for diagnostic sleep testing form and open it in the editor.
2. Begin by filling out the patient’s name in the designated section at the top of the form. Next, provide the complete address, including the city, state, and zip code.
3. Enter the home phone number, work phone number, and cell phone number in the respective fields to ensure all contact methods are available.
4. Indicate the patient's gender by marking the appropriate box, and then fill in the social security number (SSN) and date of birth (DOB).
5. Provide the patient's height and weight in the specified fields, as this information is essential for the assessment.
6. List the primary and secondary insurance information in the respective sections. Ensure the insurance details are accurate for billing purposes.
7. Identify the symptom(s) the patient is experiencing by circling the applicable ICD-9 codes listed on the form that relate to sleep disorders.
8. Mark the appropriate diagnostic procedure(s) required for the patient by selecting one or more options from the listed procedures.
9. Include a copy of the patient’s most recent medical history and insurance cards as these documents are necessary for the referral.
10. Ensure that the physician reviews and signs the letter of medical necessity, providing their printed name, date, and correct phone number.
11. Finally, save the changes you have made, and use the options available to download, print, or share the form as necessary.

Complete your referral for diagnostic sleep testing online today to facilitate the assessment of sleep disorders.