For the diagnosis and treatment of obstructive sleep apnea

Patient information

Gender:

PAP treatement

lenght of need = 99

ResMed Air

Respironics Dreamstation

Patient Preference

CPAP(EO601):

cm H2O

Auto Adjusting CPAP(EO601):

/

cm H2O

Auto Adjusting BI-LEVEL (E0470):

cm H2O

BI-LEVEL ST (E0471):

cm H2O

ASV Auto (E0471):

cm H2O

AVAPS (E0471):

cm H2O

ml

Heated Humidifier (E0562)

Mask type and supplies

All necessary PAP supplies (may include the following):
(A7046) Humidifier Chamber, (A7034) Mask Nasal, (A7030) Mask Full Face, (A7027) Mask Combo, (A7035) Headgear, (A7032) Cushion Nasal, (A7031) Cushion Full Face, (A7033) Pillow Nasal, (A7028 & A7029) Cushion Combo, (A7037) Tubing, (A4604) Tubing Heated, (A7039) Filter Reusable, (A7038) Filter Disposable, (A7036) Chin Strap

Diagnoses

Obstructive Sleep Apnea G47.33

Central Sleep Apnea G47.31

Other

If the patient's AHI/RGI is between 5 and 14.9 a secondary condition must be selected

Hypertension

Excessive Daytime Sleepiness (ESS Score >= 11)

Mood Disorders

Impaired Cognition

Insomnia

Ischemic Heart Disease

History of Stroke

Other

Prescriber's information

Same person