Get the free Kidney transplant referral form - St. Michael's Hospital

KIDNEY TRANSPLANT REFERRAL FORM Referral Criteria for Kidney Transplantation: Patients should be referred for evaluation by the transplant program once renal replacement therapy is expected to be

How to fill out kidney transplant referral form

How to fill out kidney transplant referral form

1. Obtain a copy of the kidney transplant referral form from the respective transplant center or hospital.
2. Fill out the patient's personal information accurately, including their name, date of birth, contact details, and identification number.
3. Provide information about the patient's medical history, including any previous kidney diseases or treatments.
4. Include details about the patient's current kidney function and any ongoing dialysis treatment.
5. Add information about any potential living donors, if applicable.
6. Specify the reason for the referral and include any relevant medical reports or test results.
7. Make sure to sign and date the form before submitting it to the transplant center or hospital.
8. Double-check all the information provided to ensure its accuracy and completeness.

Who needs kidney transplant referral form?

1. Individuals who are suffering from advanced kidney disease or end-stage renal failure typically need to fill out a kidney transplant referral form. This form is necessary for those seeking a kidney transplant as it allows the transplant center or hospital to evaluate the patient's eligibility for transplantation and prioritize them accordingly. It is recommended for patients who have exhausted other treatment options, such as dialysis, and are in need of a kidney transplant for improved health and quality of life.

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What is kidney transplant referral form?

The kidney transplant referral form is a document used to refer a patient with kidney disease to a transplant center for evaluation and potential transplant surgery.

Who is required to file kidney transplant referral form?

The patient's primary care physician or nephrologist is usually responsible for filing the kidney transplant referral form.

How to fill out kidney transplant referral form?

The form typically requires basic patient information, medical history, and current kidney function data to be filled out by the healthcare provider.

What is the purpose of kidney transplant referral form?

The purpose of the kidney transplant referral form is to initiate the evaluation process for a potential kidney transplant recipient.

What information must be reported on kidney transplant referral form?

The form usually requires details such as patient demographics, medical history, current medications, and any previous kidney treatments.