Get the free TAVR Referral Form - Florida Hospital

TAR PATIENT REFERRAL AND EVALUATION REQUEST PATIENT NAME PATIENT PHONE DATE OF BIRTH REFERRING PHYSICIAN PHONE The following is needed for TAR evaluation: Labs: CBC, BMP, PT/INR, BNP Demographic information

How to fill out tavr referral form

Who needs tavr referral form?

1. Patients with severe aortic stenosis: The tavr referral form is typically required for patients who have been diagnosed with severe aortic stenosis. This form helps healthcare professionals assess the patient's eligibility for transcatheter aortic valve replacement (TAVR), a minimally invasive procedure used to treat the condition.
2. Cardiologists or referring physicians: The tavr referral form is often filled out by cardiologists or referring physicians who have identified a patient with severe aortic stenosis. These healthcare providers play a crucial role in referring the patient to a specialized TAVR center for further evaluation.

How to fill out tavr referral form:

1. Patient information: Start by providing the patient's full name, date of birth, contact information, and insurance details. This information is necessary for identification and to ensure proper medical coverage.
2. Diagnosis and medical history: Indicate the patient's diagnosis of severe aortic stenosis and provide a brief summary of their medical history. This may include previous cardiac procedures, current medications, and any relevant comorbidities that may impact the TAVR procedure.
3. Referring physician details: Include the name, contact information, and specialty of the referring physician who is requesting the TAVR evaluation. This helps establish the chain of communication and ensures coordination between healthcare providers.
4. Echocardiogram and imaging results: Attach recent echocardiogram and imaging reports that confirm the presence and severity of aortic stenosis. These reports are crucial for evaluating the patient's suitability for TAVR and determining the appropriate treatment approach.
5. Other relevant documentation: If available, include any additional medical documentation that supports the referral, such as stress test results, cardiac catheterization reports, or any recent changes in the patient's condition. These documents provide a comprehensive overview of the patient's cardiovascular health.
6. Patient consent and signature: Ensure that the patient has provided informed consent for the referral process and any required procedures. The patient's signature on the referral form signifies their understanding and agreement to proceed with the TAVR evaluation.

Remember, the exact structure and content of tavr referral forms may vary depending on the healthcare institution or regional guidelines. It is essential to consult with the specific TAVR center or referring clinic to ensure accurate completion of the form.

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What is tavr referral form?

TAVR referral form is a document used to refer a patient for Transcatheter Aortic Valve Replacement procedure.

Who is required to file tavr referral form?

Cardiologists, cardiac surgeons, or other healthcare providers involved in the care of patients needing TAVR may be required to file the referral form.

How to fill out tavr referral form?

The tavr referral form can be filled out by providing patient's demographic information, medical history, and the reason for referral.

What is the purpose of tavr referral form?

The purpose of tavr referral form is to facilitate the referral process for patients in need of TAVR procedure.

What information must be reported on tavr referral form?

The tavr referral form must include patient's name, contact information, medical history, current medications, and the reason for TAVR referral.