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**PLEASE CIRCLE LOCATION IF PATIENT HAS PREFERENCE**Midtown: 350 W. Columbia St. Evansville, IN 47710 Phone: 8124505025East: 7307 E. Columbia St. Evansville, IN 47715 Phone: 8124501543Gibson: 1808
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How to fill out sleep center consultation request

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How to fill out sleep center consultation request

01
Obtain the sleep center consultation request form from your healthcare provider or download it from the sleep center's website.
02
Fill in your personal information, including your name, date of birth, and contact details.
03
Provide the name of your primary care physician or referring doctor.
04
Describe your sleep symptoms in detail, including duration and frequency of problems.
05
List any previous sleep studies or treatments you have undergone.
06
Indicate any other relevant medical history or current medications.
07
Sign and date the form to authorize the release of your medical information.
08
Submit the completed form to the sleep center, either via fax, email, or in person.

Who needs sleep center consultation request?

01
Individuals experiencing persistent sleep disorders, such as insomnia, sleep apnea, or restless leg syndrome.
02
People with ongoing fatigue or daytime drowsiness affecting their quality of life.
03
Patients with a history of sleep issues who have not responded to initial treatments.
04
Anyone advised by their healthcare provider to seek specialized sleep evaluation.
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A sleep center consultation request is a formal request made by a healthcare provider for a patient to be evaluated by a sleep specialist or to undergo sleep studies at a sleep center.
Healthcare providers, such as physicians or other qualified practitioners, are required to file a sleep center consultation request on behalf of patients who may have sleep disorders.
To fill out a sleep center consultation request, the healthcare provider typically needs to provide patient information, medical history, symptoms related to sleep issues, and any relevant tests or treatments already undertaken.
The purpose of the sleep center consultation request is to initiate a formal evaluation process for suspected sleep disorders and to ensure that patients receive appropriate diagnostic tests and treatment.
The consultation request must report patient demographics, previous medical history, specific sleep concerns, relevant symptoms, and any prior treatments related to sleep issues.
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