Verify Center and Validate Medical Order

Name of New Provider *

First

Last

This field is shown because you indicated a new provider was issuing this medical order.

Degree of Ordering Provider (Ex: M.D., P.A., etc.) *

This field is shown because you indicated a new provider was issuing this medical order.

NPI number of new Ordering Provider *

This field is shown because you indicated a new provider was issuing this medical order.

Best Phone to contact new Ordering Provider *

This field is shown because you indicated a new provider was issuing this medical order.

Email of new Ordering Provider (Will be set as the Username for the Ordering Provider) *

Email

Confirm Email

This field is shown because you indicated a new provider was issuing this medical order. NOTE: The email in this field will be assigned the Username for this Provider for this and all future medical orders online.

Enter your USERNAME on file with Snap *

NOTE: This is the same Username for your Snap Patient Portal. We require this step to comply with HIPPA policies related to online medical orders.

Enter your PASSWORD on file with Snap *

NOTE: This is the same Password for the above Username on the Snap Patient Portal. We require this step to comply with HIPPA policies related to online medical orders.

Which type of TREATMENT Medical Order do you plan to submit? *

I plan to use the online medical order from this website to order medical treatment.
I plan to upload a completed medical order for treatment given to me by my preferred treatment provider.

Regardless of which option you select, you will NOT be submitting the medical order for treatment to Snap. We are a testing company. We will assist in aggregating the materials from your patient's sleep test that you can convey to your preferred treatment partner.

Please upload the Completed Medical Order from your preferred vendor. *

NOTE: This item is being offered because you indicated above that you wanted to upload a medical order for treatment that was from your preferred treatment provider. You are electing to complete and use an alternative to completing a treatment order online via this website.

If available you can upload a Continuity of Care Document (CCD/CCDA) for this patient referral.

If you upload a Continuity of Care Document (CCD/CCDA) from your Electronic Health Record we can prepopulate much of the personal health information needed and simplify your patient referral.

How will the Medical Order signed by the Ordering Provider be given to Snap? *

The Ordering Provider will sign the online medical order now.
After submitted, please send an email to Ordering Provider to sign the order online.
After the Order is prepared, I will print the order for Ordering Provider to sign.
I will attach a signed medical order from our EHR now.

Please note: When you complete the referral form and select an Ordering Provider, the email on file for the provider will be sent a link. *

I understand

The Ordering Provider will be sent a link to review, revise (if needed), validate and sign the final form of a medical order. After a validated medical order is submitted, a Snap professional will contact your patient to conduct the ordered home sleep test.

Please note: Please provide the medical order to Snap after signed by the Ordering Provider. *

I understand

After the Order is prepared, please print the order for Ordering Provider to sign. Please scan the signed order and upload the signed order to Snap or Fax the signed order to Snap. NOTE: We cannot being to process the sleep test until we receive the signed medical order.

Please note: Please plan to upload / attach the signed medical order from your EHR. *

I understand

While preparing the online sleep test documentation, please upload / attach the Home Sleep Test Medical Order the Ordering Provider generated in your Electronic Health Record. NOTE: We cannot being to process the sleep test until we receive the signed medical order.

Please note: Please plan to have the Ordering Provider sign the medical order online after peparing the documentation. *

I understand

While preparing the online sleep test documentation, please plan to ask the Ordering Provider to sign the Home Sleep Test Medical Order. NOTE: We cannot being to process the sleep test until we receive the signed medical order.

Order a Sleep Test Online

We appreciate your patient referral. We take online security seriously.

Any patient status updates you enter on your portal are instantly communicated to the Ordering Provider's Patient Portal.

The Master Admin can add an unlimited number of additional login accounts for their organization. Turn notifications ON to get email alerts.

You can transfer any patient to another treatment provider.
The patient will move off your portal and instantly be shown on the portal for the Treatment Provider you selected.
The Ordering Provider's Patient Portal will also instantly reflect the new Treatment Provider.

Sending a patient to Snap for an HST is as Easy as 1, 2, 3.
Select the Ordering Provider for the HST.
Enter a few patient details.
Upload the Medical Order from the Ordering Provider.

This is the information we need to setup the TX Provider Account.
Please gather all of the information shown and send to Snap personnel.