US COPD Coalition

Portable Oxygen Needs Assessment Form Available for Download


There are many types of oxygen equipment used in the home, with each device having advantages and disadvantages. An assessment of a patient’s needs is crucial to matching oxygen patients with the right equipment. The United States COPD Coalition (USCC) Portable Oxygen Task Force has developed the accompanying Portable Oxygen Needs Assessment form for completion by patients, which may save time during their appointment, while providing more insight concerning the most appropriate oxygen equipment to meet their individual needs.

The form was created with input and participation by a broad committee of people from all over the US, including patients, providers, and oxygen equipment vendors. It is designed to be completed by the patient (or their caregiver) while the patient is waiting to see the their healthcare provider who will be prescribing oxygen. The completed form will help provide more information for staff to match the prescription for oxygen equipment with the patient’s needs. Ideally, the patient will get the most suitable oxygen system that optimizes health, keeps the patient actively engaged, and saves time, energy and frustration for all.

Whether you are a patient, a healthcare provider, or a home oxygen supplier, USCC encourages you to download the attached form and use it to help match the individual’s needs with the appropriate device.

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