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)
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Make/Model:
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Serial Number:
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Device Number:
PREFERRED MASK
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Type of Mask (Full Face, Nasal, Nasal Pillows):
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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.
