Application

As a physician, what you need to know to apply

1. Determine diagnosis and complete all diagnostic testing required to determine need for home oxygen. This may include ABG's, pulse oximetry at rest, on exertion, and nocturnally.
2. Sections 1 to 5 on the application form may be completed by a health care professional.  Section 6 requires physician completion and signature.  Ensure all sections are completed.
3. Attach additional clinical data if required. This may include exertional oximetry report and/or nocturnal oximetry report.
4. All doctors' offices and community referrals must contact Fraser Health Home Oxygen Program (604-514-6106) for vendor selection. 
5. All hospital or acute care facility referrals must be faxed to Medigas at 604-540-1273, and Fraser Health Home Oxygen Program at 604-514-6079.
6. Fax a copy of application and additional clinical data to the Home Oxygen Program at 604-514-6079 and the oxygen supplier.
7. For assistance in completing application refer to Fraser Health Home Oxygen Program application flowchart for adult or for infants (see resources listed below).
8. Retain original application for your records.

Infant Application Flowchart

Adult Application Flowchart

Application Form

COPD Flare Up Plan