Cardinal Sleep Prescription Request Form
Federal law requires we have a valid prescription on file before shipping a mask, machine & humidifier.
Please submit a prescription with a future expiration date, written for “lifetime need”, or “99 months”.
As long as the prescription has these prerequisites, you can purchase CPAP equipment.
If you are making the purchase of a prescription-required item without insurance, we still need a prescription to fulfill the order based on Federal regulations.
CPAP Accessories and mask parts are the only equipment sold without without a prescription.
|CPAP Mask||A7034||Every 3 months|
|CPAP headgear||A7035||Every 3-6 months|
|CPAP tubing||A7037||Every 3 months|
|Disposable filter||A7038||2 every month|
|Non-disposable fil.||A7039||2 every 6 months|
|CPAP chin strap||A7036||Every 6 months|
|Full Face mask||A7030||Every 3 months|
|Oral CPAP mask||A7044||Every 3 months|
|Humidifier chamber||A7046||Every 6 months|
|CPAP machine||E0601||3-5 years as necessary|