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Dartmouth Hitchcock ClinicsPhoneFax:Medically Urgent Fax:(603) 6503630 (603) 6764080 (603) 6401909Referring Provider: ___ Office Phone: ___ Practice Name: ___ Fax: ___ Practice Address ___PCP Name:
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How to fill out sleep disorders center referral
How to fill out sleep disorders center referral
01
Obtain a referral form from your primary care physician.
02
Fill out your personal information including name, address, and contact number.
03
Provide information on your sleep patterns, symptoms, and any past medical history related to sleep disorders.
04
Detail any medications you are currently taking and any previous treatments you have tried.
05
Have your primary care physician sign and date the referral form before submitting it to the sleep disorders center.
Who needs sleep disorders center referral?
01
Individuals experiencing symptoms of sleep disorders such as insomnia, sleep apnea, narcolepsy, restless legs syndrome, or excessive daytime sleepiness.
02
People who have already tried addressing their sleep issues with lifestyle changes or over-the-counter remedies but have not seen improvement.
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What is sleep disorders center referral?
Sleep disorders center referral is a form provided by a healthcare provider or a physician that recommends a patient to a specialized sleep disorders center for further evaluation and treatment.
Who is required to file sleep disorders center referral?
A healthcare provider or a physician is required to file a sleep disorders center referral for a patient who is showing symptoms of sleep disorders.
How to fill out sleep disorders center referral?
To fill out a sleep disorders center referral, the healthcare provider or physician must include the patient's information, symptoms, medical history, and reason for referral.
What is the purpose of sleep disorders center referral?
The purpose of sleep disorders center referral is to provide specialized care and evaluation for patients with sleep disorders to improve their quality of sleep and overall health.
What information must be reported on sleep disorders center referral?
The sleep disorders center referral must include the patient's personal information, medical history, current symptoms, and any relevant test results.
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