Name:

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

Therapy Objectives and Overview of Treatment

  • PAP therapy is the main treatment for sleep apnea. PAP machines keep your airway open by gently providing air through a mask you wear while you sleep. It can significantly improve sleep quality and reduce your risk for a number of health issues, including heart disease and stroke.
  • PAP therapy keeps airway open to allow oxygen. Reducing risk of high blood pressure, diabetes, stroke.

Mask Fitting Q & A

  • Have you ever tried PAP Therapy?
    YES
    NO
    UNKNOWN
  • Which type of mask do you prefer?
    Full Face MaskFull Face Mask
    Nasal MaskNasal Mask
    Nasal Pillow MaskNasal Pillow Mask
  • Do you have chronic allergies?
    YES
    NO
    UNKNOWN
  • Do you have a deviated septum?
    YES
    NO
    UNKNOWN
  • Do you have silicone allergy?
    YES
    NO
    UNKNOWN
  • Do you have thick facial hair?
    YES
    NO
    UNKNOWN
  • Do you breathe though your mouth while sleeping?
    YES
    NO
    UNKNOWN
  • Do you have claustrophobia?
    YES
    NO
    UNKNOWN
  • Do you wear glasses while reading or watching TV, while trying to fall asleep?
    YES
    NO
    UNKNOWN
  • Do you prefer to sleep on your back or side?
    Back
    Side
    UNKNOWN
  • Do you have any kind of hand injury or wrist problems that may cause trouble in putting on your mask or adjusting the straps?
    YES
    NO
    UNKNOWN
  • Do you suffer from cognitive issues?
    YES
    NO
    UNKNOWN

Equipment Compliance Guidelines

  • To meet compliance guidelines for treating sleep apnea, you should use the PAP machine for at least 4 hours per night and 70% for first 90 days. If you use the machine for less than this required amount, there is a chance your insurance will stop paying for your treatment.

Overview of Equipment Usage

  • A PAP machine treats sleep apnea by delivering air pressure through a mask to lift the airway tissues so that they do not collapse and cause obstruction when you’re breathing at night.

You may visit this link PAP Machine and Supplies for more information about the types of machine and masks.

I understand that the above information has given me a proper orientation about PAP therapy, importance of compliance guidelines and determining mask selection.
By submitting this checklist, I authorize MyApneaPath to disclose the information supplied to the DME vendor to process the order for my PAP equipment and supplies.

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