Referral form
Sleep study referral
A sleep-study referral asks a sleep laboratory or home-study provider to test for sleep-disordered breathing or another sleep diagnosis you actually suspect. Hospital labs, independent facilities, and provincial programs each print a PDF. It is not a CPAP prescription, not an ENT referral, and not “tired, please fix.”
What the lab is protocoling
They need the suspected diagnosis, why now, and whether this should be an in-lab (Level 1) night or a home (Level 3) study. Unexplained sleepiness in a commercial driver is not the same request as snoring in a person who already failed a home study. Write the occupational stake if there is one.
Use the lab’s current requisition so they have the right funding box (OHIP-insured vs uninsured vs WCB vs insurer). A pad from another city will bill the wrong payer or bounce.
A screening score is not a diagnosis
STOP-BANG or Epworth can support the referral. They do not replace an indication sentence. Do not invent scores you did not record.
Who completes it
The physician or nurse practitioner who assessed sleepiness, snoring, or the other indication. Some labs require a sleep-physician screen; others accept primary care. Follow the form. Do not sign a study for a partner who wants “proof” without an assessment of the patient.
How to complete the referral
- Indication: suspected OSA, suspected narcolepsy, parasomnia, restudy after weight change or surgery — one main question.
- Symptoms: witnessed apneas, choking, unrefreshing sleep, sleepiness while driving — with a time course.
- BMI, neck, hypertension, heart failure, opioids, alcohol as they apply. Do not skip BMI on an OSA form.
- Level 1 vs home study if the form lets you choose, with a reason (cardiorespiratory comorbidity, failed home study, occupational).
- Medications that sedate or affect respiration.
- Shift work and safety-sensitive jobs. The lab may still run the test; the employer medical is a different form.
If you already know you want CPAP, you still usually need a diagnostic study unless the program has another pathway. Do not write “start CPAP” on a blank sleep requisition and expect a machine to appear.
Worked example (fictional)
Sleep study — suspected OSA, family practice
Fictional 49-year-old. Do not copy into a real sleep-lab form.
Question: suspected moderate–severe OSA. Loud snoring, witnessed pauses, sleepiness on the highway twice this year (pulled over). ESS 14. STOP-BANG 6. BMI 34. HTN on amlodipine. No heart failure. No opioids. Prefer in-lab if the unit triages commercial-adjacent driving risk; otherwise home study acceptable per lab protocol. Not a truck medical — that is a separate driver form. Not ENT. Not a CPAP Rx today. I am the FP.
Why labs send it back
- No indication beyond “tired.”
- Wrong payer box (WCB injury vs insured medical vs cash).
- Asking for MSLT on a first OSA screen without a reason.
- Missing BMI or medications on a form that requires them.
- Referring the wrong person (bed partner’s symptoms only).
Draft the sleep-study referral from the visit
In Scribeberry, open Forms, search for sleep study referral or polysomnography, or upload the lab’s current PDF. Generate from the encounter and your notes, then review every field before you send. Scribeberry does not pre-map this form. You still review and sign. Scribeberry does not book the lab.
Frequently asked questions
Level 1 or home study?
Follow the lab’s protocol and the patient’s comorbidity. Complex cardiorespiratory disease, failed home studies, and some occupational files often need in-lab testing. If you are unsure, state the indication and let the lab protocol — do not guess a billing code you do not use.
Is this a driver medical?
No. A sleep study can inform fitness to drive. The provincial driver medical is a separate form. Do not treat the sleep requisition as an MTO or CCMTA certificate.
Can I order CPAP on this form?
Usually no. This form books a test. Funding a machine follows the study and the provincial or insurer rules. Complete the form in front of you.
Does Scribeberry book the sleep study?
No. Scribeberry helps you complete the PDF. You send it to the lab. Keep a copy in the chart.
Forms
