You can download copies of these forms to use at your convenience. You will need Acrobat Reader to view the file. Acrobat Reader is free and can be obtained from the Adobe site.

New Patient Forms

(see below for New Child Patient Forms)

New Adult Patient Registration

HIPAA Notice (Privacy Policy)

HIPAA Acknowledgement

Adult Medical Records Disclosure and Medical Records Release


Patient Forms

Headache Diary

Sleep Diary

Sleep Study Information

Sleep Study Questionnaire

Comment or Complaint

Narcotic Contract


Child Neurology Forms

New Child Patient Registration

New Child Patient Registration (Patients of Dr. Milowic only)

HIPAA Acknowledgement

Child Medical Records Disclosure and Medical Records Release

Guardian Release Form

Child Patient Profile

Child Headache Calendar

Sleep Diary


Map to Our Office

Map to RNA

 

David Johnson, MD
Raleigh Neurology Associates is proud to welcome … More
Sleep Medicine Services & Procedures

Sleep Disorders

The FDA recently approved special Adaptive Servo Ventilation PAP equipment for the effective treatment of Central Apnea as well as Cheyne-Strokes Breathing in Congestive Heart Failure.

As of March 3, 2006 the Sleep Medicine Program became one of only a handful of Sleep Disorder Centers in the United States to provide this new mode of therapy.

Inquiries and referrals should be directed to the Sleep Medicine Program at 919-788-9071.

Sleep Disorders

  • Obstructive Sleep Apnea
  • Upper Airway Resistance Syndrome
  • Obesity Hypoventilation Syndrome
  • Central Sleep Apnea
  • Cheyne-Strokes Breathing with Congestive Heart Failure
  • Nocturnal Hypoxemia
  • Parasomnias
  • Seizures/Epilepsy Monitoring with Synchronous Digital Video
  • Restless Legs Syndrome
  • Periodic Limb Movements in Sleep
  • Tests:
  • Diagnostic Polysomnogram
  • Pediatric Polysomnogram with EtCO2
  • CPAP/Bilevel PAP/O2 Ttitration
  • Home Pulse Oximetry
  • Narcolepsy
  • Idiopathic Daytime Sleepiness
  • DOT & FAA clearance and management

Tests

  • Multiple Sleep Latency Test
  • Maintenance of Wakefulness Test

We feature the latest equipment including Adaptive Servo Ventilation to effectively treat Central Apnea and Cheyne-Stokes Breathing in Congestive Heart Failure.

Consultation with Dr. Perkins is available for any Sleep Disorder.

All patients are offered follow-up and comprehensive Sleep Medicine management.

Patient Referrals

Phone: 919-788-9071
Fax: 919-420-6088