Dear Referring Physician,                                                                                  

We have received your request for Sleep Laboratory services, but require additional information to complete scheduling.

The attached FAX referral form should be completed, including the doctor’s signature, and returned to 505-474-6525.  You can also fax records that contain the following information:

·         An office registration form with demographic and insurance information; and

·         A recent H&P or other clinic notes that describes the patient’s problem and the indication (suspected diagnosis) for sleep testing.

Please note that if we do not examine the patient at the Sleep Center prior to testing (direct referral), we must have:

·         A clear description of the requested service;

·         A statement of suspected diagnosis (OSA, other sleep-disturbed breathing, narcolepsy);

·         Records of the patient’s condition, for reasons of patient safety and appropriate care during Sleep Laboratory visit;

·         The referring doctor’s signature.

·         We can advise on therapy but cannot issue the prescription.

Please note that if the patient is referred for consultation at the Sleep Center Clinic prior to testing, we do not require any additional documents.  Sleep testing will be performed as determined by the consultant.

Please note that Polysomnography (sleep testing) is indicated for specific diagnoses:  Obstructive sleep apnea (OSA), other sleep disturbed breathing (SDB) such as central sleep apnea, treatment evaluation for SDB (e.g. CPAP), narcolepsy.

Polysomnography is NOT indicated for:  insomnia, restless legs syndrome, parasomnias and other sleep disorders, UNLESS there is reason to suspect an associated authorized indication (OSA, other SDB, narcolepsy), which should be referenced in the referral.

When sleep testing is not indicated by the diagnosis, please consider consultation at the Sleep Center.

Thank you for helping us provide the appropriate care for your patient; and helping us comply with the many regulations that govern our practice and affect reimbursement.

Wolfgang Schmidt-Nowara, MD

Medical Director