BCOH Sleep Apnea Referral

Referrals

For physicians who want to refer their patients to our office for treatment for sleep apnea, please download and fill out our referral form.

Patient's Information


Patient's Email


Patient's Address

Patient's Phone Number


Patient's DOB


Requesting Physician's Information



Sleep Study Available:


YesNo

Reason for referral (Mark all that apply)

Diagnosis:


Obstructive Sleep Apnea (ICD 327.23)Hypersomnia due to Sleep Apnea (ICD 780.53)Insomnia due to Sleep Apnea ( ICD 780.51)Other , unspecified (ICD 780.57)

Baseline Data (without CPAP or Oral Appliance)

AHI


RDI


Lowest Desaturation (SpO2)


T90

Therapies attempted:


CPAP

Surgery
YesNo

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Request A Presentation

For physicians want to learn more about oral appliance therapy, please request a presentation by contacting us.

Phone: (617) 536-4620
Email: bcoh@bcoh.com

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