Please read and complete the PAP Orientation Checklist. This form is required by the DME provider prior to shipping out the supplies.

PAP MACHINE (Please provide information if available)

  • Make/Model:
  • Serial Number:
  • Device Number:


  • Type of Mask (Full Face, Nasal, Nasal Pillows):
  • Size:

Importance of Changing Supplies

  • Replacing your supplies is essential for optimal comfort and proper operation of your PAP device. It also prevents infection.

Supply Replacement Schedule
Every Month

  • Mask cushions and/or nasal pillows
  • Machine filters

Every 3 Months

  • Mask frame
  • Tubing

Every 6 Months

  • Filters (non-disposable)
  • Headgear
  • Chinstrap
  • Humidifier water tub

I acknowledge that I have understand and was properly informed about the importance of changing PAP supplies.
By submitting this checklist, I authorize MyApneaPath to disclose the information supplied to the DME vendor to process the order for my PAP supplies.