CPAP/BIPAP Equipment Choice List
Dear Patient and Family:
Your physician has ordered/recommended a Respiratory Assist Device (CPAP/BIPAP) after you leave the hospital.
St. Vincent`s Durable Medical Equipment, which is owned in part by St. Vincent`s Health System, can provide the services or supplies ordered/recommended by your provider.
You have the right to select any provider to provide the care ordered/recommended by your physician. This is your choice.
Patient or Family, please check one of the following:
In compliance with our policy, the absence of an affirmative choice by the patient or representative, the default is to the ST. VINCENT`S DURABLE MEDICAL EQUIPMENT.
List the best number for the Provider to use when contacting you:
Patient or Responsible Party (State Relationship) Date
St. Vincent`s Sleep Disorders Center Representative Date
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: CPAP/BIPAP Equipment Choice List
Agree & Sign