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Sleep Literature

  • National Sleep Foundation: Sleep Disorders
  • National Institutes of Health
         National Institute of Neurological Disorders        and Stroke
            Brain Basics: Understanding Sleep
         National Heart, Lung, and Blood Institute
            In Brief: Your Guide to Healthy Sleep
            Sleep Deprivation and Deficiency
            National Center on Sleep Disorders Center
  • Center for Disease Control (CDC)

    • Referring Physician

    We welcome your interest in evaluating your patients for Sleep Disorders. Please have your patient complete the following Sleep Assessment Form. We appreciate your trust and referrals.

    Sleep Assessment Form

    Patient’s name:

    Date of Birth:

    Gender:

    		Male  Female

    Primary Insurance:

    Patient phone No:


    PRIOR SLEEP TESTING & TREATMENT

    Have you ever been diagnosed with a Sleep Disorder?

    		Yes No

    If yes, when and what diagnosis did you receive?

    Has your Sleep Disorder Treatment resolved your symptoms?

    		Yes No

    Do you use a CPAP when sleeping?

    		Yes No

    Do you use prescription or over the counter Sleep Aids?

    		Yes No

    PRIOR SLEEP TESTING & TREATMENT

    Do you Snore?

    		Yes No

    Are you excessively tired during waking hours?

    Have you been told that you stop breathing during sleep?

    		Yes No

    Do you have a history of Hypertension? Diabetes? Stroke?

    		Yes No

    Are you overweight? Neck size > 17inch (male) or > 16inch (female)?

    		Yes No
    “YES” to two (or more) of these questions is a positive screen for Sleep Apnea.

    Referral for Sleep Specific Assessment

                             
    Referring Physician               Referring Physician NPI #             Physician phone number

                            
    Physician Fax Number          Physician Office Address             Referral Date

    Abha Mishra, MD, Medical Director. Sleep Lab Phone (228) 284-1656, Scheduling: (228) 596-4686, Lab Fax: (228) 2655718, E-Mail: gulfportsleepcenter@gmail.com.

        

    Sleep Disorders & Test

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