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Get and Sign Images of a Sleep Study Referral Form

Get and Sign Sleep Study Referral Form

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Apnea History of prior documented sleep apnea Snoring Sleep Paralysis Falls asleep during the day Hypertension Falls asleep while driving Morning headaches Daytime fatigue History of prior upper airway surgery Normal Sleeping Hours: From ______ to ______ Night Day Evening MEDICAL CONDITIONS: GERD Diabetes Cardiac arrhythmia Other: CHF Seizures Chronic Pain Stroke/Weakness Seizures ALS Frequent awakenings from sleep Restless legs symptoms Difficulty getting to...
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