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Fax: 4162348807 (During Office Hours) Tel.: 18667191192 (24 hours / 7 days) Email: info@advacare.ca HOME OXYGEN REFERRAL FORM REASON FOR REFERRAL Home Oxygen Setup (Please complete Prescription Section)

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How to fill out home oxygen therapy referral

01

Obtain a prescription from a qualified healthcare provider specifying the need for home oxygen therapy.

02

Contact a durable medical equipment provider who offers home oxygen services.

03

Provide all necessary personal and insurance information to the equipment provider.

04

Schedule an evaluation with a respiratory therapist to determine the appropriate oxygen equipment.

05

Complete any required paperwork and consent forms.

06

Wait for approval from the insurance company before starting home oxygen therapy.

Who needs home oxygen therapy referral?

01

Patients diagnosed with chronic obstructive pulmonary disease (COPD)

02

Patients with severe asthma

03

Individuals with cystic fibrosis

04

Patients with lung cancer or other respiratory diseases

05

People experiencing acute respiratory failure

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What is home oxygen therapy referral?

Home oxygen therapy referral is a process where a patient is recommended to receive oxygen therapy in their home by a healthcare provider.

Who is required to file home oxygen therapy referral?

Home oxygen therapy referral is typically filed by a healthcare provider such as a doctor or respiratory therapist.

How to fill out home oxygen therapy referral?

To fill out a home oxygen therapy referral, the healthcare provider must provide the patient's medical information, oxygen requirements, and reason for the therapy.

What is the purpose of home oxygen therapy referral?

The purpose of home oxygen therapy referral is to ensure that patients who require oxygen therapy receive it in their home to improve their quality of life and health.

What information must be reported on home oxygen therapy referral?

Information such as the patient's medical history, oxygen saturation levels, oxygen flow rate, and duration of therapy must be reported on the home oxygen therapy referral.

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