Get the free Heart Transplant Referral - Saint Lukes Health System
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4401 Worn all Road Kansas Cities, MO 64111 8169323264 office 8169327575 fax Heart Transplant Referral Patient Information Patient Name DOB Age Home Address City State ZIP SSN Homework Cell Primary
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How to fill out heart transplant referral
How to fill out heart transplant referral?
01
Obtain the heart transplant referral form from the appropriate healthcare provider or hospital.
02
Fill in your personal information accurately, including your full name, date of birth, contact information, and insurance details.
03
Provide a detailed medical history, including any current and past medical conditions, surgeries, and medications you are taking.
04
Include information about your current heart condition and the reasons why you believe a heart transplant is necessary.
05
If you have seen any specialists or cardiologists, provide their contact information and any relevant reports or test results.
06
Indicate your willingness and readiness to undergo a heart transplant procedure, including any necessary lifestyle changes you have made to improve your overall health.
07
Sign and date the referral form, ensuring that you have read and understood the information provided.
08
Submit the completed heart transplant referral form to the designated healthcare provider or hospital, following any specific submission instructions they may have.
Who needs heart transplant referral?
01
Patients with end-stage heart failure or other severe heart conditions that cannot be managed effectively with medication or other treatments may require a heart transplant referral.
02
Individuals who have undergone thorough medical evaluation by cardiologists or heart specialists and have been deemed suitable candidates for a heart transplant will typically need a referral.
03
Patients who have exhausted all other available treatment options and have been advised by their healthcare team that a heart transplant is the most appropriate course of action will also require a referral.
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What is heart transplant referral?
Heart transplant referral is the process of referring a patient to a specialized center for evaluation and potential placement on the heart transplant waiting list.
Who is required to file heart transplant referral?
The patient's primary care physician or cardiologist is typically responsible for initiating the heart transplant referral.
How to fill out heart transplant referral?
The referring physician will need to complete a referral form with the patient's medical history, test results, and current medications.
What is the purpose of heart transplant referral?
The purpose of heart transplant referral is to assess the patient's suitability for a heart transplant and to determine if they meet the criteria for placement on the waiting list.
What information must be reported on heart transplant referral?
The heart transplant referral should include the patient's medical history, test results (such as echocardiograms and catheterizations), current medications, and any relevant documentation.
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