We just need the following information:

1. Basic Patient Information (or fax face sheet 315.339.4134)

• Name
• Address & phone number
• Insurance information
• Diagnosis
• Height and Weight
  
  

2. Type of Equipment

3. When Ordering Oxygen:

• Sat % or ABG
• Date Sat % of ABG was performed
  
  

4. Name of the Ordering Physician

5. Discharge Information

• Date
• Time
• Room Number if Applicable