{"id":2496,"date":"2018-08-16T16:55:27","date_gmt":"2018-08-16T06:55:27","guid":{"rendered":"https:\/\/sleepandlungcare.com.au\/?page_id=2496"},"modified":"2026-10-17T14:54:47","modified_gmt":"2026-10-17T03:54:47","slug":"online-referrals","status":"publish","type":"page","link":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/","title":{"rendered":"\u0627\u0644\u0625\u062d\u0627\u0644\u0629 \u0639\u0628\u0631 \u0627\u0644\u0625\u0646\u062a\u0631\u0646\u062a"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"2496\" class=\"elementor elementor-2496\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-316f2023 pbmit-col-stretched-none pbmit-cursor-color-blackish-color pbmit-bg-color-over-image elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"316f2023\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1bb7a9cf pbmit-bg-color-over-image\" data-id=\"1bb7a9cf\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3366fb0b elementor-widget elementor-widget-text-editor\" data-id=\"3366fb0b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h1 style=\"text-align: center;\">\u0627\u0644\u0625\u062d\u0627\u0644\u0629 \u0639\u0628\u0631 \u0627\u0644\u0625\u0646\u062a\u0631\u0646\u062a \u0644\u0644\u0623\u0637\u0628\u0627\u0621<\/h1><p style=\"text-align: center;\"><strong>\u062a\u064f\u063a\u0637\u0651\u0649 \u062a\u0643\u0644\u0641\u0629 \u0641\u062d\u0648\u0635\u0627\u062a \u0648\u0638\u0627\u0626\u0641 \u0627\u0644\u0631\u0626\u0629 \u0648\u062f\u0631\u0627\u0633\u0627\u062a \u0627\u0644\u0646\u0648\u0645 \u0627\u0644\u0645\u0646\u0632\u0644\u064a\u0629 \u0627\u0644\u0645\u0624\u0647\u0644\u0629 \u0628\u0627\u0644\u0643\u0627\u0645\u0644 \u0639\u0628\u0631 Medicare (bulk billed) \u0645\u0639 \u0648\u062c\u0648\u062f \u0625\u062d\u0627\u0644\u0629 \u0633\u0627\u0631\u064a\u0629. \u0623\u0645\u0627 \u0631\u0633\u0648\u0645 \u0627\u0644\u0627\u0633\u062a\u0634\u0627\u0631\u0629 \u0648\u0623\u064a \u0631\u0633\u0648\u0645 \u0644\u062f\u0631\u0627\u0633\u0627\u062a \u0627\u0644\u0646\u0648\u0645 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 \u0641\u0647\u064a \u0645\u0646\u0641\u0635\u0644\u0629\u061b \u0648\u0633\u064a\u0634\u0631\u062d \u0644\u0643 \u0642\u0633\u0645 \u0627\u0644\u0627\u0633\u062a\u0642\u0628\u0627\u0644 \u0627\u0644\u0631\u0633\u0648\u0645 \u0627\u0644\u0645\u0637\u0628\u0651\u0642\u0629 \u0642\u0628\u0644 \u0627\u0644\u062d\u062c\u0632.<\/strong><\/p><p class=\"translation-block\">\u0647\u0630\u0627 \u0627\u0644\u0646\u0645\u0648\u0630\u062c \u0645\u062e\u0635\u0651\u0635 \u0644\u0644\u0623\u0637\u0628\u0627\u0621 \u0627\u0644\u0645\u064f\u062d\u064a\u0644\u064a\u0646. \u0648\u0639\u0644\u0649 \u0627\u0644\u0645\u0631\u0636\u0649 \u0627\u0644\u0630\u064a\u0646 \u0644\u062f\u064a\u0647\u0645 \u0631\u0633\u0627\u0644\u0629 \u0625\u062d\u0627\u0644\u0629 \u0628\u0627\u0644\u0641\u0639\u0644 \u0627\u0633\u062a\u062e\u062f\u0627\u0645 <a href=\"https:\/\/sleepandlungcare.com.au\/ar\/upload-your-referral\/\">\u0627\u0631\u0641\u0639 \u0631\u0633\u0627\u0644\u0629 \u0625\u062d\u0627\u0644\u062a\u0643<\/a>.<\/p><p><p class=\"salc-form-note salc-notice\" data-no-translation data-no-dynamic-translation lang=\"ar\" dir=\"rtl\">\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0625\u062d\u0627\u0644\u0629 \u0647\u0630\u0627 \u0645\u062e\u0635\u0635 \u0644\u0644\u0623\u0637\u0628\u0627\u0621 \u0627\u0644\u0645\u062d\u064a\u0644\u064a\u0646 \u0648\u0647\u0648 \u0628\u0627\u0644\u0644\u063a\u0629 \u0627\u0644\u0625\u0646\u062c\u0644\u064a\u0632\u064a\u0629.<\/p><div class=\"salc-form-en\" data-no-translation data-no-dynamic-translation lang=\"en-AU\" dir=\"ltr\"><style type=\"text\/css\">.super-form:not(.super-initialized) *:not(.super-load-icon) { visibility: hidden !important; }<\/style><div id=\"super-form-3621\" style=\"margin:0px 0px 0px 0px;\" class=\"super-form super-form-3621  super-default-squared super-field-size-medium\" data-hide=\"true\" data-overlay=\"true\" data-disable-enter=\"true\" data-field-size=\"medium\"><span class=\"super-load-icon\"><\/span><form tabindex=\"0\" autocomplete=\"on\" enctype=\"multipart\/form-data\" action=\"\"><input type=\"hidden\" name=\"sf_nonce\" value=\"\" \/><input type=\"hidden\" name=\"super_create_nonce\" value=\"35a9065e26\" \/><input type=\"text\" name=\"super_hp\" size=\"25\" value=\"\" \/><div class=\"super-shortcode super-field super-hidden\"><input class=\"super-shortcode-field\" type=\"hidden\" value=\"3621\" name=\"hidden_form_id\" \/><\/div><div class=\"super-shortcode super-field super-checkbox super-has-only-label   super-ungrouped   display-vertical\"><div class=\"super-label super-bottom-margin\">Referral priority<\/div><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"URGENT\" \/><div>URGENT \u2013 review within 48 hours requested (suspected lung cancer or lung mass, or rapidly worsening symptoms)<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"urgent\" value=\"\" data-oname=\"urgent\" data-email=\"Priority:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column\"><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-1 first-column\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"patient_first\" data-oname=\"patient_first\" data-validation=\"empty\" data-email=\"First name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Patient first name(s)*\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-2\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"patient_surname\" data-oname=\"patient_surname\" data-validation=\"empty\" data-email=\"Surname:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Patient surname*\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-1 first-column\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"address\" data-oname=\"address\" data-validation=\"empty\" data-may-be-empty=\"true\" data-email=\"Address:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Address\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"phonenumber\" data-oname=\"phonenumber\" data-validation=\"phone\" data-email=\"Phone\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Phone*\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-2\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_2\" data-oname=\"name_2\" data-message=\"Please enter the date of birth as dd\/mm\/yyyy.\" data-validation=\"empty\" data-email=\"Date of Birth:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Date of Birth* (dd\/mm\/yyyy)\" \/><\/div><div class=\"super-error-msg\">Please enter the date of birth as dd\/mm\/yyyy.<\/div><div class=\"super-empty-error-msg\">Please enter the date of birth as dd\/mm\/yyyy.<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-1 first-column\"><div class=\"super-shortcode super-field super-checkbox   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Consultation with a Specialist Physician\" \/><div>Consultation with a Specialist Physician<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"option\" value=\"\" data-oname=\"option\" data-email=\"Consultation with a Specialist Physician\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-checkbox super-has-only-label   super-ungrouped   display-vertical\"><div class=\"super-label super-bottom-margin\">Sleep Study<\/div><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Hospital based sleep study (privately insured patients)\" \/><div>Hospital-based sleep study (privately insured patients)<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Home based sleep study\" \/><div>Home-based sleep study * (Bulk Billed)<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_XPcrS\" value=\"\" data-oname=\"field_XPcrS\" data-email=\"Sleep Study * (Bulk Billed)\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"color:#ff0000; font-size:10px;\">* Please complete the ESS and STOP-Bang questionnaires. For a direct referral based on screening scores, Medicare requires ESS \u2265 8 and either STOP-Bang \u2265 3, OSA-50 \u2265 5 or a high-risk Berlin score.<br \/>\n<\/span><\/div><textarea><span style=\"color:#ff0000; font-size:10px;\">* Please complete the ESS and STOP-Bang questionnaires. For a direct referral based on screening scores, Medicare requires ESS \u2265 8 and either STOP-Bang \u2265 3, OSA-50 \u2265 5 or a high-risk Berlin score.<br \/>\n<\/span><\/textarea><textarea class=\"super-shortcode-field super-hidden\" name=\"field_fLExe\" data-oname=\"field_fLExe\" data-exclude=\"2\" data-exclude-entry=\"true\" data-absolute-default=\"\" ><span style=\"color:#ff0000; font-size:10px;\">* Please complete the ESS and STOP-Bang questionnaires. For a direct referral based on screening scores, Medicare requires ESS \u2265 8 and either STOP-Bang \u2265 3, OSA-50 \u2265 5 or a high-risk Berlin score.<br \/>\n<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-2\"><div class=\"super-shortcode super-field super-checkbox super-has-only-label   super-ungrouped   display-vertical\"><div class=\"super-label super-bottom-margin\">Respiratory Function Tests <\/div><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Spirometry &amp; Transfer Factor\" \/><div>Spirometry &#038; Transfer Factor<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"FeNO &amp; Spirometry\" \/><div>FeNO &#038; Spirometry<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Plethysmographic Lung Volumes\" \/><div>Plethysmographic Lung Volumes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Bronchial Provocation Test\" \/><div>Bronchial Provocation Test<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Maximal Respiratory Pressures\" \/><div>Maximal Respiratory Pressures<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"6 minute walk test\" \/><div>6-minute walk test<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"checkbox\" value=\"Ambulatory Oxygen Assessment\" \/><div>Ambulatory Oxygen Assessment<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_XTinn\" value=\"\" data-oname=\"field_XTinn\" data-email=\"Respiratory Function Tests:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-dropdown super-has-only-label  super-filled  super-ungrouped\"><div class=\"super-label super-bottom-margin\">Preferred clinic<\/div><div class=\"super-field-wrapper\"><input type=\"hidden\" class=\"super-shortcode-field\" name=\"preferred_clinic\" value=\"No preference\" data-oname=\"preferred_clinic\" data-email=\"Preferred clinic:\" data-exclude=\"0\" data-absolute-default=\"No preference\" data-default-value=\"No preference\" placeholder=\"- select a clinic -\" \/><input tabindex=\"-1\" type=\"text\" name=\"super-dropdown-search\" value=\"\" data-logic=\"contains\" \/><ul class=\"super-dropdown-list\"><li data-value=\"\" class=\"super-item super-placeholder\">No preference \u2013 closest to the patient<\/li><li class=\"super-item super-default-selected super-active\" data-value=\"No preference\" data-search-value=\"No preference \u2013 closest to the patient\"><div>No preference \u2013 closest to the patient<\/div><\/li><li class=\"super-item\" data-value=\"Epping\" data-search-value=\"Epping\"><div>Epping<\/div><\/li><li class=\"super-item\" data-value=\"Brunswick\" data-search-value=\"Brunswick\"><div>Brunswick<\/div><\/li><li class=\"super-item\" data-value=\"Doncaster East\" data-search-value=\"Doncaster East\"><div>Doncaster East<\/div><\/li><li class=\"super-item\" data-value=\"Braybrook\" data-search-value=\"Braybrook\"><div>Braybrook<\/div><\/li><li class=\"super-item\" data-value=\"Kilmore\" data-search-value=\"Kilmore\"><div>Kilmore<\/div><\/li><\/ul><span class=\"super-dropdown-arrow\"><span class=\"super-after\"><i class=\"fas fa-caret-down\"><\/i><\/span><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><div class=\"salc-prep salc-prep-gp\"><h3>Withholding times for lung function tests<\/h3><p>If you are ordering lung function tests, please give the patient these withholding times &mdash; a long-acting inhaler taken that morning may invalidate the pre-bronchodilator result, and the test may have to be repeated. Patients should not stop a medicine they need to stay safe. <a href=\"https:\/\/sleepandlungcare.com.au\/respiratory-function-tests\/#preparing\" target=\"_blank\" rel=\"noopener\">Printable patient version &rarr;<\/a><\/p><div class=\"salc-tablewrap\"><table class=\"salc-table\"><thead><tr><th>Medicine (examples)<\/th><th>Spirometry, lung volumes, gas transfer, FeNO<\/th><th>Bronchial provocation (mannitol)<\/th><\/tr><\/thead><tbody><tr><td>Reliever puffers \u2014 salbutamol (Ventolin, Asmol, Airomir), terbutaline (Bricanyl)<\/td><td>4\u20136 hours<\/td><td>8 hours<\/td><\/tr><tr><td>Ipratropium (Atrovent)<\/td><td>12 hours<\/td><td>12 hours<\/td><\/tr><tr><td>Twice-daily long-acting and combination inhalers \u2014 Seretide, Symbicort, Flutiform, DuoResp, Fostair, Serevent, Oxis<\/td><td>24 hours<\/td><td>36 hours<\/td><\/tr><tr><td>Once-daily long-acting inhalers \u2014 Breo Ellipta, Trelegy, Anoro, Ultibro, Spiolto, Onbrez, Striverdi<\/td><td>36\u201348 hours<\/td><td>72 hours<\/td><\/tr><tr><td>Twice-daily triple-therapy inhalers (they contain a long-acting anticholinergic) \u2014 Trimbow, Breztri<\/td><td>36\u201348 hours<\/td><td>72 hours<\/td><\/tr><tr><td>Long-acting anticholinergics \u2014 Spiriva, Seebri, Incruse, Bretaris<\/td><td>36\u201348 hours<\/td><td>72 hours<\/td><\/tr><tr><td>Preventer-only inhaled steroid \u2014 Flixotide, Pulmicort, Qvar, Alvesco<\/td><td>Take as usual<\/td><td>Skip the morning dose (6 hours)<\/td><\/tr><tr><td>Montelukast (Singulair)<\/td><td>Take as usual<\/td><td>4 days<\/td><\/tr><tr><td>Antihistamines \u2014 Zyrtec, Claratyne, Telfast, Phenergan<\/td><td>Take as usual<\/td><td>72 hours<\/td><\/tr><tr><td>Theophylline (Nuelin)<\/td><td>Take as usual<\/td><td>24 hours<\/td><\/tr><tr><td>Caffeine \u2014 coffee, tea, cola, energy drinks, chocolate<\/td><td>Avoid on the morning of the test<\/td><td>24 hours<\/td><\/tr><tr><td>Smoking or vaping<\/td><td>Not within 1 hour<\/td><td>Not within 1 hour<\/td><\/tr><tr><td>Alcohol<\/td><td>Not within 8 hours<\/td><td>Not within 8 hours<\/td><\/tr><tr><td>Vigorous exercise \u00b7 a large meal<\/td><td>Not within 1 hour \u00b7 not within 2 hours<\/td><td>Not within 1 hour \u00b7 not within 2 hours<\/td><\/tr><\/tbody><\/table><\/div><\/div><\/div><textarea><div class=\"salc-prep salc-prep-gp\"><h3>Withholding times for lung function tests<\/h3><p>If you are ordering lung function tests, please give the patient these withholding times &mdash; a long-acting inhaler taken that morning may invalidate the pre-bronchodilator result, and the test may have to be repeated. Patients should not stop a medicine they need to stay safe. <a href=\"https:\/\/sleepandlungcare.com.au\/respiratory-function-tests\/#preparing\" target=\"_blank\" rel=\"noopener\">Printable patient version &rarr;<\/a><\/p><div class=\"salc-tablewrap\"><table class=\"salc-table\"><thead><tr><th>Medicine (examples)<\/th><th>Spirometry, lung volumes, gas transfer, FeNO<\/th><th>Bronchial provocation (mannitol)<\/th><\/tr><\/thead><tbody><tr><td>Reliever puffers \u2014 salbutamol (Ventolin, Asmol, Airomir), terbutaline (Bricanyl)<\/td><td>4\u20136 hours<\/td><td>8 hours<\/td><\/tr><tr><td>Ipratropium (Atrovent)<\/td><td>12 hours<\/td><td>12 hours<\/td><\/tr><tr><td>Twice-daily long-acting and combination inhalers \u2014 Seretide, Symbicort, Flutiform, DuoResp, Fostair, Serevent, Oxis<\/td><td>24 hours<\/td><td>36 hours<\/td><\/tr><tr><td>Once-daily long-acting inhalers \u2014 Breo Ellipta, Trelegy, Anoro, Ultibro, Spiolto, Onbrez, Striverdi<\/td><td>36\u201348 hours<\/td><td>72 hours<\/td><\/tr><tr><td>Twice-daily triple-therapy inhalers (they contain a long-acting anticholinergic) \u2014 Trimbow, Breztri<\/td><td>36\u201348 hours<\/td><td>72 hours<\/td><\/tr><tr><td>Long-acting anticholinergics \u2014 Spiriva, Seebri, Incruse, Bretaris<\/td><td>36\u201348 hours<\/td><td>72 hours<\/td><\/tr><tr><td>Preventer-only inhaled steroid \u2014 Flixotide, Pulmicort, Qvar, Alvesco<\/td><td>Take as usual<\/td><td>Skip the morning dose (6 hours)<\/td><\/tr><tr><td>Montelukast (Singulair)<\/td><td>Take as usual<\/td><td>4 days<\/td><\/tr><tr><td>Antihistamines \u2014 Zyrtec, Claratyne, Telfast, Phenergan<\/td><td>Take as usual<\/td><td>72 hours<\/td><\/tr><tr><td>Theophylline (Nuelin)<\/td><td>Take as usual<\/td><td>24 hours<\/td><\/tr><tr><td>Caffeine \u2014 coffee, tea, cola, energy drinks, chocolate<\/td><td>Avoid on the morning of the test<\/td><td>24 hours<\/td><\/tr><tr><td>Smoking or vaping<\/td><td>Not within 1 hour<\/td><td>Not within 1 hour<\/td><\/tr><tr><td>Alcohol<\/td><td>Not within 8 hours<\/td><td>Not within 8 hours<\/td><\/tr><tr><td>Vigorous exercise \u00b7 a large meal<\/td><td>Not within 1 hour \u00b7 not within 2 hours<\/td><td>Not within 1 hour \u00b7 not within 2 hours<\/td><\/tr><\/tbody><\/table><\/div><\/div><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-textarea   super-ungrouped\"><div class=\"super-field-wrapper\"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question\" data-oname=\"question\" data-email=\"Clinical Notes:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Clinical Notes\" ><\/textarea><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-file super-has-label-desc   super-ungrouped\"><div class=\"super-label\">Attach the referral letter (optional)<\/div><div class=\"super-description\">A PDF, or a photo of each page (JPG, PNG or HEIC). Up to 3 files, 10 MB each. If you attach nothing, this form itself is filed as the referral.<\/div><div class=\"super-field-wrapper\"><div class=\"super-fileupload-button\"><i class=\"fas fa-plus\"><\/i><span class=\"super-fileupload-button-text\">Choose file(s)<\/span><\/div><input tabindex=\"-1\" class=\"super-shortcode-field super-fileupload\" type=\"file\" name=\"files[]\"  data-file-size=\"10\" data-upload-limit=\"30\" data-accept-file-types=\"pdf|jpg|jpeg|png|heic|heif|PDF|JPG|JPEG|PNG|HEIC|HEIF\" multiple \/><input class=\"super-active-files\" type=\"hidden\" value=\"\" name=\"referral_letter\" data-oname=\"referral_letter\" data-message=\"Please attach a PDF, JPG, PNG or HEIC file of 10 MB or less.\" data-email=\"Referral letter:\" data-exclude=\"1\" data-absolute-default=\"\" data-maxfiles=\"3\" \/><div class=\"super-progress-bar\"><\/div><div class=\"super-fileupload-files\"><\/div><\/div><div class=\"super-error-msg\">Please attach a PDF, JPG, PNG or HEIC file of 10 MB or less.<\/div><div class=\"super-empty-error-msg\">Please attach a PDF, JPG, PNG or HEIC file of 10 MB or less.<\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped\"><div class=\"super-heading-title\"><h3>Requesting Doctor <\/h3><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-1 first-column\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"doctor_first\" data-oname=\"doctor_first\" data-message=\"Please enter your first name.\" data-validation=\"empty\" data-email=\"Doctor first name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Doctor first name*\" \/><\/div><div class=\"super-error-msg\">Please enter your first name.<\/div><div class=\"super-empty-error-msg\">Please enter your first name.<\/div><\/div><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"doctor_surname\" data-oname=\"doctor_surname\" data-message=\"Please enter your surname.\" data-validation=\"empty\" data-email=\"Doctor surname:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Doctor surname*\" \/><\/div><div class=\"super-error-msg\">Please enter your surname.<\/div><div class=\"super-empty-error-msg\">Please enter your surname.<\/div><\/div><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_XgkVh\" data-oname=\"field_XgkVh\" data-validation=\"empty\" data-email=\"Address\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Address*\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_egsAK\" data-oname=\"field_egsAK\" data-email=\"Copy report to:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Copy report to (other doctors)\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"phonenumber_1\" data-oname=\"phonenumber_1\" data-validation=\"phone\" data-email=\"Phone\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Phone*\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-2\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name\" data-oname=\"name\" data-validation=\"empty\" data-email=\"Provider number\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Provider number*\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"email\" data-oname=\"email\" data-message=\"Please enter the practice email address.\" data-validation=\"email\" data-email=\"Practice email:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Practice email* (we confirm receipt here)\" \/><\/div><div class=\"super-error-msg\">Please enter the practice email address.<\/div><div class=\"super-empty-error-msg\">Please enter the practice email address.<\/div><\/div><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><div class=\"salc-sig\" data-salc-sig><p class=\"salc-sig-noscript\">Signature: please enable JavaScript to sign on screen.<\/p><\/div><\/div><textarea><div class=\"salc-sig\" data-salc-sig><p class=\"salc-sig-noscript\">Signature: please enable JavaScript to sign on screen.<\/p><\/div><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-hidden   super-ungrouped   hidden\"><input class=\"super-shortcode-field\" type=\"hidden\" name=\"salc_sig_img\" data-oname=\"salc_sig_img\" value=\"\" data-default-value=\"\" data-absolute-default=\"\" data-email=\"Signature image:\" data-exclude=\"2\" \/><\/div><div class=\"super-shortcode super-field super-hidden   super-ungrouped   hidden\"><input class=\"super-shortcode-field\" type=\"hidden\" name=\"salc_sig_method\" data-oname=\"salc_sig_method\" value=\"\" data-default-value=\"\" data-absolute-default=\"\" data-email=\"Signature:\" \/><\/div><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_1\" data-oname=\"name_1\" data-email=\"Fax\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" placeholder=\"Fax\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped\"><div class=\"super-heading-title\"><h3>EPWORTH SLEEPINESS SCALE (ESS)<\/h3><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\">Use the 0\u20133 scale to choose the most appropriate number for each situation<\/div><textarea>Use the 0\u20133 scale to choose the most appropriate number for each situation<\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\">0 = would never doze<br \/>\n1 = slight chance of dozing<br \/>\n2 = moderate chance of dozing<br \/>\n3 = high chance of dozing<br \/>\n<\/div><textarea>0 = would never doze<br \/>\n1 = slight chance of dozing<br \/>\n2 = moderate chance of dozing<br \/>\n3 = high chance of dozing<br \/>\n<\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column\"><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-1 first-column\"><div class=\"super-shortcode super-field super-heading   super-ungrouped\"><div class=\"super-heading-title\"><h3>SITUATION <\/h3><\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-2\"><div class=\"super-shortcode super-field super-heading   super-ungrouped\"><div class=\"super-heading-title\"><h3>CHANCE OF DOZING (0 &#8211; 3)<\/h3><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-1 column-number-1 first-column\"><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting and reading<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting and reading<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"Sitting_and_reading\" value=\"0\" data-steps=\"1\" data-oname=\"Sitting_and_reading\" data-email=\"Sitting and reading:\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Watching TV<br \/>\n<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Watching TV<br \/>\n<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"Watching_TV\" value=\"0\" data-steps=\"1\" data-oname=\"Watching_TV\" data-email=\"Watching TV:\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting, inactive in a public place (e.g. a theatre or a meeting)<br \/>\n<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting, inactive in a public place (e.g. a theatre or a meeting)<br \/>\n<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_rKhTn\" value=\"0\" data-steps=\"1\" data-oname=\"field_rKhTn\" data-email=\"Sitting, inactive in a public place (e.g. a theatre or a meeting):\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> As a passenger in a car for an hour without a break<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> As a passenger in a car for an hour without a break<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_OQuAp\" value=\"0\" data-steps=\"1\" data-oname=\"field_OQuAp\" data-email=\"As a passenger in a car for an hour without a break:\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Lying down to rest in the afternoon when circumstances permit<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Lying down to rest in the afternoon when circumstances permit<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_zzzMP\" value=\"0\" data-steps=\"1\" data-oname=\"field_zzzMP\" data-email=\"Lying down to rest in the afternoon when circumstances permit:\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting and talking to someone<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting and talking to someone<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_LolCd\" value=\"0\" data-steps=\"1\" data-oname=\"field_LolCd\" data-email=\"Sitting and talking to someone:\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting quietly after a lunch without alcohol<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> Sitting quietly after a lunch without alcohol<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_Qahty\" value=\"0\" data-steps=\"1\" data-oname=\"field_Qahty\" data-email=\"Sitting quietly after a lunch without alcohol:\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> In a car, while stopped for a few minutes in the traffic<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\"> In a car, while stopped for a few minutes in the traffic<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-quantity   super-ungrouped\"><div class=\"super-quantity-field-wrap\"><span class=\"super-minus-button super-noselect\"><i>&#8211;<\/i><\/span><div style=\"width:50px;\" class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_uGjHK\" value=\"0\" data-steps=\"1\" data-oname=\"field_uGjHK\" data-email=\"In a car, while stopped for a few minutes in the traffic:\" data-exclude=\"0\" data-absolute-default=\"0\" data-default-value=\"0\" data-minnumber=\"0\" data-maxnumber=\"3\" \/><\/div><span class=\"super-plus-button super-noselect\"><i>+<\/i><\/span><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 20px; font-family: \"open sans\",sans-serif; color:#000000;\"> Write down total score<\/span><\/div><textarea><span style=\"font-size: 20px; font-family: \"open sans\",sans-serif; color:#000000;\"> Write down total score<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"color:#ff0000; font-size:10px;\">For a direct referral based on screening scores, the ESS score needs to be \u2265 8.<\/span><\/div><textarea><span style=\"color:#ff0000; font-size:10px;\">For a direct referral based on screening scores, the ESS score needs to be \u2265 8.<\/span><\/textarea><textarea class=\"super-shortcode-field super-hidden\" name=\"filed_ZZmmp\" data-oname=\"filed_ZZmmp\" data-email=\"HTML:\" data-exclude=\"2\" data-exclude-entry=\"true\" data-absolute-default=\"\" ><span style=\"color:#ff0000; font-size:10px;\">For a direct referral based on screening scores, the ESS score needs to be \u2265 8.<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_3\" data-oname=\"name_3\" data-email=\"Total Score:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column\"><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped\"><div class=\"super-heading-title\"><h3>STOP-Bang QUESTIONNAIRE<\/h3><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Do you SNORE loudly? <\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Do you SNORE loudly? <\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"option_1\" value=\"\" data-oname=\"option_1\" data-email=\"Do you SNORE loudly? :\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Do you often feel TIRED, fatigued, or sleepy during the daytime? <\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Do you often feel TIRED, fatigued, or sleepy during the daytime? <\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_zoCZo\" value=\"\" data-oname=\"field_zoCZo\" data-email=\"Do you often feel TIRED, fatigued, or sleepy during the daytime? :\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Has anyone OBSERVED you stop breathing or choke or gasp for air during your sleep? <\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Has anyone OBSERVED you stop breathing or choke or gasp for air during your sleep? <\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_JVBZY\" value=\"\" data-oname=\"field_JVBZY\" data-email=\"Has anyone OBSERVED you stop breathing or choke or gasp for air during your sleep? :\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Do you have or are you being treated for high blood PRESSURE? <\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Do you have or are you being treated for high blood PRESSURE? <\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_BSxyC\" value=\"\" data-oname=\"field_BSxyC\" data-email=\"Do you have or are you being treated for high blood PRESSURE? :\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">BMI more than 35 kg\/m\u00b2?<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">BMI more than 35 kg\/m\u00b2?<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_gPHGo\" value=\"\" data-oname=\"field_gPHGo\" data-email=\"BMI more than 35 kg per m2 ? :\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Age over 50 years old? <\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Age over 50 years old? <\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_KVqOJ\" value=\"\" data-oname=\"field_KVqOJ\" data-email=\"Age over 50 years old? :\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Neck circumference 43 cm or more (men) \/ 41 cm or more (women)?<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Neck circumference 43 cm or more (men) \/ 41 cm or more (women)?<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_RsOpz\" value=\"\" data-oname=\"field_RsOpz\" data-email=\"Neck circumference 43 cm or more (men) \/ 41 cm or more (women)?:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-3\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Gender: Male?<\/span><\/div><textarea><span style=\"font-size: 14px; font-family: \"open sans\",sans-serif; color:#000000;\">Gender: Male?<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_fourth super-column grid-level-0 column-number-4\"><div class=\"super-shortcode super-field super-radio   super-ungrouped   display-vertical\"><div class=\"super-field-wrapper\"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"yes\" \/><div>Yes<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"no\" \/><div>No<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"field_JMOsX\" value=\"\" data-oname=\"field_JMOsX\" data-email=\"Gender: Male?:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column\"><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"font-size: 20px; font-family: \"open sans\",sans-serif; color:#000000;\"> Write down total YES score<\/span><\/div><textarea><span style=\"font-size: 20px; font-family: \"open sans\",sans-serif; color:#000000;\"> Write down total YES score<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><div class=\"super-shortcode super-field super-html   super-ungrouped\"><div class=\"super-html-content\"><span style=\"color:#ff0000; font-size:10px;\">For the STOP-Bang direct-referral pathway, the STOP-Bang score needs to be \u2265 3 and the ESS score needs to be \u2265 8.<br \/>\n<\/span><\/div><textarea><span style=\"color:#ff0000; font-size:10px;\">For the STOP-Bang direct-referral pathway, the STOP-Bang score needs to be \u2265 3 and the ESS score needs to be \u2265 8.<br \/>\n<\/span><\/textarea><textarea class=\"super-shortcode-field super-hidden\" name=\"field_nZVPY\" data-oname=\"field_nZVPY\" data-exclude=\"2\" data-exclude-entry=\"true\" data-absolute-default=\"\" ><span style=\"color:#ff0000; font-size:10px;\">For the STOP-Bang direct-referral pathway, the STOP-Bang score needs to be \u2265 3 and the ESS score needs to be \u2265 8.<br \/>\n<\/span><\/textarea><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2\"><div class=\"super-shortcode super-field super-text   super-ungrouped\"><div class=\"super-field-wrapper\"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"field_EPbdX\" data-oname=\"field_EPbdX\" data-email=\"Total Yes Score:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><div class=\"super-empty-error-msg\">\u0627\u0644\u062d\u0642\u0644 \u0645\u0637\u0644\u0648\u0628!<\/div><\/div><\/div><\/div><div data-color=\"#f20800\" data-light=\"#ff1c14\" data-dark=\"#d40000\" data-hover-color=\"#444444\" data-hover-light=\"#585858\" data-hover-dark=\"#262626\" data-font=\"#ffffff\" data-font-hover=\"#ffffff\" data-radius=\"square\" data-type=\"flat\" class=\"super-extra-shortcode super-shortcode super-field super-button super-clear-none super-form-button super-radius-square super-type-flat super-button-large super-button-align-left super-button-width-auto\"><div data-href=\"\" class=\"super-button-wrap no_link\"><div class=\"super-button-name\" data-action=\"submit\" data-normal=\"Submit\" data-loading=\"Loading...\">Submit<\/div><span class=\"super-after\"><\/span><\/div><\/div><input type=\"hidden\" name=\"trp-form-language\" value=\"ar\"\/><\/form><\/div><\/div><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Online Referral for GPs Bulk billing is available for home sleep studies and respiratory function tests with a valid referral.<\/p>","protected":false},"author":11,"featured_media":9287,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"rs_blank_template":"","rs_page_bg_color":"","slide_template_v7":"","footnotes":""},"class_list":["post-2496","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Online Referral Form for GPs | Sleep and Lung Care<\/title>\n<meta name=\"description\" content=\"Refer a patient online for a consultation, lung function tests or an eligible bulk billed home sleep study. Includes the Epworth and STOP-Bang questionnaires Medicare requires.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/\" \/>\n<meta property=\"og:locale\" content=\"ar_AR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Online Referral Form for GPs | Sleep and Lung Care\" \/>\n<meta property=\"og:description\" content=\"Refer a patient online for a consultation, lung function tests or an eligible bulk billed home sleep study. Includes the Epworth and STOP-Bang questionnaires Medicare requires.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/\" \/>\n<meta property=\"og:site_name\" content=\"Sleep and Lung Care\" \/>\n<meta property=\"article:modified_time\" content=\"2026-10-17T03:54:47+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/sleepandlungcare.com.au\/wp-content\/uploads\/2023\/10\/iStock-695218436.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1600\" \/>\n\t<meta property=\"og:image:height\" content=\"1067\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/\",\"name\":\"Online Referral Form for GPs | Sleep and Lung Care\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/wp-content\\\/uploads\\\/2023\\\/10\\\/iStock-695218436.webp\",\"datePublished\":\"2018-08-16T06:55:27+00:00\",\"dateModified\":\"2026-10-17T03:54:47+00:00\",\"description\":\"Refer a patient online for a consultation, lung function tests or an eligible bulk billed home sleep study. Includes the Epworth and STOP-Bang questionnaires Medicare requires.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/#breadcrumb\"},\"inLanguage\":\"ar\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"ar\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/#primaryimage\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/wp-content\\\/uploads\\\/2023\\\/10\\\/iStock-695218436.webp\",\"contentUrl\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/wp-content\\\/uploads\\\/2023\\\/10\\\/iStock-695218436.webp\",\"width\":1600,\"height\":1067,\"caption\":\"For doctors: refer a patient to Sleep and Lung Care\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/online-referrals\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/ar\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Online Referral\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/#website\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/\",\"name\":\"Sleep and Lung Care\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-AU\"},{\"@type\":[\"MedicalOrganization\",\"Organization\"],\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/#organization\",\"name\":\"Sleep and Lung Care\",\"alternateName\":\"Sleep & Lung Care\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"ar\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/wp-content\\\/uploads\\\/2018\\\/06\\\/dmd-Sleep-_-Lung-Care-logo-2-e1539502583960.png\",\"contentUrl\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/wp-content\\\/uploads\\\/2018\\\/06\\\/dmd-Sleep-_-Lung-Care-logo-2-e1539502583960.png\",\"width\":250,\"height\":180,\"caption\":\"Sleep and Lung Care\"},\"image\":{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.healthdirect.gov.au\\\/australian-health-services\\\/healthcare-service\\\/epping-3076-vic\\\/sleep-and-lung-care-epping\\\/pulmonary-medicine-service\\\/47509c58-ac5a-56d1-3c6b-367226c73fcf\",\"https:\\\/\\\/www.healthshare.com.au\\\/practices\\\/sleep-and-lung-care\\\/22852-epping-3076\\\/\",\"https:\\\/\\\/www.google.com\\\/maps?cid=14984205713445593390\",\"https:\\\/\\\/www.google.com\\\/maps?cid=7353079142284182143\",\"https:\\\/\\\/www.google.com\\\/maps?cid=18115290743171746048\",\"https:\\\/\\\/www.google.com\\\/maps?cid=18335186465836059051\",\"https:\\\/\\\/www.google.com\\\/maps?cid=12246870546291512960\"],\"description\":\"Sleep and Lung Care provides adult respiratory and sleep medicine consultations, lung function tests and sleep study services at clinics in Epping, Brunswick, Doncaster East, Braybrook and Kilmore, Victoria.\",\"telephone\":\"+61 3 9422 0077\",\"faxNumber\":\"+61 3 9454 9339\",\"email\":\"reception@sleepandlungcare.com.au\",\"medicalSpecialty\":[\"Pulmonary\",\"Sleep medicine\"],\"areaServed\":[\"Melbourne\",\"Victoria\"],\"isAcceptingNewPatients\":true,\"department\":[{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/respiratory-sleep-physicians-epping\\\/#clinic\"},{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/respiratory-sleep-physicians-brunswick\\\/#clinic\"},{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/respiratory-sleep-physicians-doncaster-east\\\/#clinic\"},{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/respiratory-sleep-physicians-braybrook\\\/#clinic\"},{\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/respiratory-sleep-physicians-kilmore\\\/#clinic\"}],\"physician\":[{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-irena-laska\\\/#physician\",\"name\":\"Dr Irena Laska\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-irena-laska\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-maitri-munsif\\\/#physician\",\"name\":\"Dr Maitri Munsif\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-maitri-munsif\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jibin-thomas\\\/#physician\",\"name\":\"Dr Jibin Thomas\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jibin-thomas\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-daniel-niewodowski\\\/#physician\",\"name\":\"Dr Daniel Niewodowski\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-daniel-niewodowski\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-benjamin-leaver\\\/#physician\",\"name\":\"Dr Benjamin Leaver\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-benjamin-leaver\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-bassem-dawood\\\/#physician\",\"name\":\"Dr Bassem Dawood\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-bassem-dawood\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jayne-roberts\\\/#physician\",\"name\":\"Dr Jayne Roberts\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jayne-roberts\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-ashwin-rajan\\\/#physician\",\"name\":\"Dr Ashwin Rajan\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-ashwin-rajan\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/mr-bibhusal-thapa\\\/#physician\",\"name\":\"Mr Bibhusal Thapa\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/mr-bibhusal-thapa\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-cara-tanner\\\/#physician\",\"name\":\"Dr Cara Tanner\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-cara-tanner\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jessica-nash\\\/#physician\",\"name\":\"Dr Jessica Nash\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jessica-nash\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-raymond-wong\\\/#physician\",\"name\":\"Dr Raymond Wong\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-raymond-wong\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-sanjeevan-muruganandan\\\/#physician\",\"name\":\"Associate Professor Sanjeevan Muruganandan\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-sanjeevan-muruganandan\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-kanishka-rangamuwa\\\/#physician\",\"name\":\"Dr Kanishka Rangamuwa\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-kanishka-rangamuwa\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-julien-robinson\\\/#physician\",\"name\":\"Dr Julien Robinson\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-julien-robinson\\\/\"},{\"@type\":\"Physician\",\"@id\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jack-henderson\\\/#physician\",\"name\":\"Dr Jack Henderson\",\"url\":\"https:\\\/\\\/sleepandlungcare.com.au\\\/team-member\\\/dr-jack-henderson\\\/\"}]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0625\u062d\u0627\u0644\u0629 \u0639\u0628\u0631 \u0627\u0644\u0625\u0646\u062a\u0631\u0646\u062a \u0644\u0644\u0623\u0637\u0628\u0627\u0621 | Sleep and Lung Care","description":"\u0623\u062d\u0650\u0644 \u0645\u0631\u064a\u0636\u064b\u0627 \u0639\u0628\u0631 \u0627\u0644\u0625\u0646\u062a\u0631\u0646\u062a \u0644\u0627\u0633\u062a\u0634\u0627\u0631\u0629 \u0623\u0648 \u0641\u062d\u0648\u0635\u0627\u062a \u0648\u0638\u0627\u0626\u0641 \u0627\u0644\u0631\u0626\u0629 \u0623\u0648 \u062f\u0631\u0627\u0633\u0629 \u0646\u0648\u0645 \u0645\u0646\u0632\u0644\u064a\u0629 \u0645\u0624\u0647\u0644\u0629 \u0645\u063a\u0637\u0627\u0629 \u0628\u0627\u0644\u0643\u0627\u0645\u0644 \u0639\u0628\u0631 Medicare. \u064a\u062a\u0636\u0645\u0646 \u0627\u0633\u062a\u0628\u064a\u0627\u0646\u064a Epworth \u0648STOP-Bang \u0627\u0644\u0644\u0630\u064a\u0646 \u064a\u062a\u0637\u0644\u0628\u0647\u0645\u0627 Medicare.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/","og_locale":"ar_AR","og_type":"article","og_title":"Online Referral Form for GPs | Sleep and Lung Care","og_description":"Refer a patient online for a consultation, lung function tests or an eligible bulk billed home sleep study. Includes the Epworth and STOP-Bang questionnaires Medicare requires.","og_url":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/","og_site_name":"Sleep and Lung Care","article_modified_time":"2026-10-17T03:54:47+00:00","og_image":[{"width":1600,"height":1067,"url":"https:\/\/sleepandlungcare.com.au\/wp-content\/uploads\/2023\/10\/iStock-695218436.webp","type":"image\/webp"}],"twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/","url":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/","name":"\u0646\u0645\u0648\u0630\u062c \u0627\u0644\u0625\u062d\u0627\u0644\u0629 \u0639\u0628\u0631 \u0627\u0644\u0625\u0646\u062a\u0631\u0646\u062a \u0644\u0644\u0623\u0637\u0628\u0627\u0621 | Sleep and Lung Care","isPartOf":{"@id":"https:\/\/sleepandlungcare.com.au\/#website"},"primaryImageOfPage":{"@id":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/#primaryimage"},"image":{"@id":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/#primaryimage"},"thumbnailUrl":"https:\/\/sleepandlungcare.com.au\/wp-content\/uploads\/2023\/10\/iStock-695218436.webp","datePublished":"2018-08-16T06:55:27+00:00","dateModified":"2026-10-17T03:54:47+00:00","description":"\u0623\u062d\u0650\u0644 \u0645\u0631\u064a\u0636\u064b\u0627 \u0639\u0628\u0631 \u0627\u0644\u0625\u0646\u062a\u0631\u0646\u062a \u0644\u0627\u0633\u062a\u0634\u0627\u0631\u0629 \u0623\u0648 \u0641\u062d\u0648\u0635\u0627\u062a \u0648\u0638\u0627\u0626\u0641 \u0627\u0644\u0631\u0626\u0629 \u0623\u0648 \u062f\u0631\u0627\u0633\u0629 \u0646\u0648\u0645 \u0645\u0646\u0632\u0644\u064a\u0629 \u0645\u0624\u0647\u0644\u0629 \u0645\u063a\u0637\u0627\u0629 \u0628\u0627\u0644\u0643\u0627\u0645\u0644 \u0639\u0628\u0631 Medicare. \u064a\u062a\u0636\u0645\u0646 \u0627\u0633\u062a\u0628\u064a\u0627\u0646\u064a Epworth \u0648STOP-Bang \u0627\u0644\u0644\u0630\u064a\u0646 \u064a\u062a\u0637\u0644\u0628\u0647\u0645\u0627 Medicare.","breadcrumb":{"@id":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/#breadcrumb"},"inLanguage":"ar","potentialAction":[{"@type":"ReadAction","target":["https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/"]}]},{"@type":"ImageObject","inLanguage":"ar","@id":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/#primaryimage","url":"https:\/\/sleepandlungcare.com.au\/wp-content\/uploads\/2023\/10\/iStock-695218436.webp","contentUrl":"https:\/\/sleepandlungcare.com.au\/wp-content\/uploads\/2023\/10\/iStock-695218436.webp","width":1600,"height":1067,"caption":"For doctors: refer a patient to Sleep and Lung Care"},{"@type":"BreadcrumbList","@id":"https:\/\/sleepandlungcare.com.au\/ar\/online-referrals\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/sleepandlungcare.com.au\/ar\/"},{"@type":"ListItem","position":2,"name":"Online Referral"}]},{"@type":"WebSite","@id":"https:\/\/sleepandlungcare.com.au\/#website","url":"https:\/\/sleepandlungcare.com.au\/","name":"Sleep and Lung Care","description":"","publisher":{"@id":"https:\/\/sleepandlungcare.com.au\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/sleepandlungcare.com.au\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-AU"},{"@type":["MedicalOrganization","Organization"],"@id":"https:\/\/sleepandlungcare.com.au\/#organization","name":"Sleep and Lung Care","alternateName":"Sleep & Lung Care","url":"https:\/\/sleepandlungcare.com.au\/","logo":{"@type":"ImageObject","inLanguage":"ar","@id":"https:\/\/sleepandlungcare.com.au\/#\/schema\/logo\/image\/","url":"https:\/\/sleepandlungcare.com.au\/wp-content\/uploads\/2018\/06\/dmd-Sleep-_-Lung-Care-logo-2-e1539502583960.png","contentUrl":"https:\/\/sleepandlungcare.com.au\/wp-content\/uploads\/2018\/06\/dmd-Sleep-_-Lung-Care-logo-2-e1539502583960.png","width":250,"height":180,"caption":"Sleep and Lung Care"},"image":{"@id":"https:\/\/sleepandlungcare.com.au\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.healthdirect.gov.au\/australian-health-services\/healthcare-service\/epping-3076-vic\/sleep-and-lung-care-epping\/pulmonary-medicine-service\/47509c58-ac5a-56d1-3c6b-367226c73fcf","https:\/\/www.healthshare.com.au\/practices\/sleep-and-lung-care\/22852-epping-3076\/","https:\/\/www.google.com\/maps?cid=14984205713445593390","https:\/\/www.google.com\/maps?cid=7353079142284182143","https:\/\/www.google.com\/maps?cid=18115290743171746048","https:\/\/www.google.com\/maps?cid=18335186465836059051","https:\/\/www.google.com\/maps?cid=12246870546291512960"],"description":"Sleep and Lung Care provides adult respiratory and sleep medicine consultations, lung function tests and sleep study services at clinics in Epping, Brunswick, Doncaster East, Braybrook and Kilmore, Victoria.","telephone":"+61 3 9422 0077","faxNumber":"+61 3 9454 9339","email":"reception@sleepandlungcare.com.au","medicalSpecialty":["Pulmonary","Sleep medicine"],"areaServed":["Melbourne","Victoria"],"isAcceptingNewPatients":true,"department":[{"@id":"https:\/\/sleepandlungcare.com.au\/respiratory-sleep-physicians-epping\/#clinic"},{"@id":"https:\/\/sleepandlungcare.com.au\/respiratory-sleep-physicians-brunswick\/#clinic"},{"@id":"https:\/\/sleepandlungcare.com.au\/respiratory-sleep-physicians-doncaster-east\/#clinic"},{"@id":"https:\/\/sleepandlungcare.com.au\/respiratory-sleep-physicians-braybrook\/#clinic"},{"@id":"https:\/\/sleepandlungcare.com.au\/respiratory-sleep-physicians-kilmore\/#clinic"}],"physician":[{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-irena-laska\/#physician","name":"Dr Irena Laska","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-irena-laska\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-maitri-munsif\/#physician","name":"Dr Maitri Munsif","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-maitri-munsif\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jibin-thomas\/#physician","name":"Dr Jibin Thomas","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jibin-thomas\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-daniel-niewodowski\/#physician","name":"Dr Daniel Niewodowski","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-daniel-niewodowski\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-benjamin-leaver\/#physician","name":"Dr Benjamin Leaver","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-benjamin-leaver\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-bassem-dawood\/#physician","name":"Dr Bassem Dawood","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-bassem-dawood\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jayne-roberts\/#physician","name":"Dr Jayne Roberts","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jayne-roberts\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-ashwin-rajan\/#physician","name":"Dr Ashwin Rajan","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-ashwin-rajan\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/mr-bibhusal-thapa\/#physician","name":"Mr Bibhusal Thapa","url":"https:\/\/sleepandlungcare.com.au\/team-member\/mr-bibhusal-thapa\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-cara-tanner\/#physician","name":"Dr Cara Tanner","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-cara-tanner\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jessica-nash\/#physician","name":"Dr Jessica Nash","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jessica-nash\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-raymond-wong\/#physician","name":"Dr Raymond Wong","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-raymond-wong\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-sanjeevan-muruganandan\/#physician","name":"Associate Professor Sanjeevan Muruganandan","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-sanjeevan-muruganandan\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-kanishka-rangamuwa\/#physician","name":"Dr Kanishka Rangamuwa","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-kanishka-rangamuwa\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-julien-robinson\/#physician","name":"Dr Julien Robinson","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-julien-robinson\/"},{"@type":"Physician","@id":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jack-henderson\/#physician","name":"Dr Jack Henderson","url":"https:\/\/sleepandlungcare.com.au\/team-member\/dr-jack-henderson\/"}]}]}},"_links":{"self":[{"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/pages\/2496","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/comments?post=2496"}],"version-history":[{"count":48,"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/pages\/2496\/revisions"}],"predecessor-version":[{"id":14685,"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/pages\/2496\/revisions\/14685"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/media\/9287"}],"wp:attachment":[{"href":"https:\/\/sleepandlungcare.com.au\/ar\/wp-json\/wp\/v2\/media?parent=2496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}