Clark Referral Process
"5 Easy Steps"
1-800-260-1190

1. Basic Patient Information (or fax the face sheet)
   • Name(877)878-4137
   • Address
   • Insurance information
   • Diagnosis
2. Name of the ordering Physician
3. Type of Equipment
4. When Ordering Oxygen
   • Sat % or ABG
   • Date Sat % of ABG was performed
   • How test was performed: At rest, during exercise, or during sleep.
5. Discharge Informaion
   • Date
   • Time
   • Room Number if Applicable
   • Special needs