Get the free Kidney Donor Intake Form - fillable - swedishorg

Kidney Donor Intake Form All fields are required unless labeled optional. Demographic Data First Name (legal name): Middle Initial: Last Name:

How to fill out kidney donor intake form

How to fill out kidney donor intake form:

1. Obtain the kidney donor intake form from the transplantation center or hospital where you are planning to donate your kidney.
2. Carefully read through the instructions provided on the form to familiarize yourself with the required information.
3. Start by providing your personal details such as your name, date of birth, address, contact number, and email address.
4. Next, disclose any relevant medical history, such as previous surgeries, illnesses, or current medications you are taking.
5. Fill in your family medical history, including any hereditary conditions or diseases that may be of concern.
6. Provide information about your lifestyle habits, such as smoking, alcohol consumption, and recreational drug use.
7. Answer questions regarding your mental health and any history of mental illnesses.
8. In some cases, you may need to provide documentation or proof of your identity, such as a photocopy of your passport or driver's license.
9. Ensure that you sign and date the form, acknowledging that all the information provided is true and accurate to the best of your knowledge.
10. After completion, submit the filled-out kidney donor intake form to the transplantation center or hospital.

Who needs kidney donor intake form?

1. Individuals who are considering donating their kidney for transplantation.
2. People who have expressed their interest in becoming a kidney donor.
3. Individuals who have met the initial screening requirements to be potential kidney donors.
4. Candidates who have been referred to a transplantation center or hospital for further evaluation and assessment.
5. Patients who are in need of a kidney transplant and have potential donors coming forward.
6. Healthcare professionals involved in the evaluation and selection process of potential kidney donors.
7. Organizations and institutions that facilitate kidney transplantation and require complete documentation for their records.

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