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Get the free PM Sleep Lab Referral Form-KC updated 09 2011 2 .doc

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Let us know when patient is scheduled: YES NO Date Scheduled: One night for a Lifetime of Better Sleep FAX: 913-721-5402 OFFICE: 913-721-5511 Lab Location Patient Prefers: Hutton Rd, KICK KC/Liberty
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PM sleep lab referral is a medical referral for a patient to undergo a sleep study at a sleep lab in the afternoon or evening.
Healthcare providers such as physicians, nurse practitioners, or physician assistants are required to file PM sleep lab referrals.
PM sleep lab referrals can be filled out by providing the patient's demographic information, medical history, and reason for referral.
The purpose of PM sleep lab referral is to diagnose and treat sleep disorders such as sleep apnea or insomnia.
Information that must be reported on PM sleep lab referral includes patient's name, date of birth, insurance information, and referring provider's details.
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