UT Erlanger Kidney Transplant Center Referral Form 2012 free printable template

18 Apr 2012 ... Chattanooga, TN 37403. Phone: (423) 778-8067. Fax: (423) 778-6674. Health System. UT Erlang her Kidney Transplant Center Referral Form.

How to fill out UT Erlanger Kidney Transplant Center Referral

How to fill out UT Erlanger Kidney Transplant Center Referral Form

1. Obtain the UT Erlanger Kidney Transplant Center Referral Form from the official website or request it from your healthcare provider.
2. Fill out the patient's personal information section, including name, date of birth, and contact information.
3. Provide the patient's medical history, including details of kidney disease and any previous treatments.
4. Include information about the referring physician, including name, contact information, and their relationship to the patient.
5. Attach any necessary medical documents, such as lab results or imaging studies, that support the referral.
6. Review the form for completeness and accuracy before submitting.
7. Submit the completed referral form through the specified method, whether by fax, email, or mail.

Who needs UT Erlanger Kidney Transplant Center Referral Form?

1. Patients diagnosed with end-stage renal disease or severe chronic kidney disease who may require a kidney transplant.
2. Patients being evaluated for kidney transplant candidacy by their nephrologist or primary care physician.
3. Individuals referred by healthcare professionals who believe a kidney transplant may be a suitable treatment option.

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What is UT Erlanger Kidney Transplant Center Referral Form?

The UT Erlanger Kidney Transplant Center Referral Form is a document used by healthcare professionals to refer patients for evaluation and potential kidney transplant at the UT Erlanger facility.

Who is required to file UT Erlanger Kidney Transplant Center Referral Form?

Healthcare providers, including primary care physicians and nephrologists, are required to file the UT Erlanger Kidney Transplant Center Referral Form on behalf of patients who may need a kidney transplant.

How to fill out UT Erlanger Kidney Transplant Center Referral Form?

To fill out the UT Erlanger Kidney Transplant Center Referral Form, the referrer must provide patient details, medical history, relevant lab results, and any additional information pertinent to the kidney transplant evaluation.

What is the purpose of UT Erlanger Kidney Transplant Center Referral Form?

The purpose of the UT Erlanger Kidney Transplant Center Referral Form is to initiate the evaluation process for patients who may be eligible for a kidney transplant and to facilitate communication between the referring physician and the transplant center.

What information must be reported on UT Erlanger Kidney Transplant Center Referral Form?

The UT Erlanger Kidney Transplant Center Referral Form must include patient demographics, medical history, current medications, laboratory results, and indication for the referral along with any other relevant clinical information.