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Nicoletta Kidney Transplant Center 833 Chestnut St, Suite 138 Philadelphia PA 19107 Phone 18888556649 Fax 2155034290LIVING KIDNEY DONOR SCREENING Questionnaire office use only: Date receivedBMIDonor
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How to fill out Jefferson Health Living Donor Medical Assessment and
01
Obtain the Jefferson Health Living Donor Medical Assessment form from the provided sources.
02
Fill out personal information, including name, address, date of birth, and contact details.
03
Provide a complete medical history, including any past surgeries, chronic illnesses, and medications currently taken.
04
List any known allergies and previous hospitalizations.
05
Complete the psychosocial assessment section by answering questions related to mental health and support systems.
06
Schedule a physical examination with the designated medical professional.
07
Submit the completed form along with any required documentation to the designated contact at Jefferson Health.
Who needs Jefferson Health Living Donor Medical Assessment and?
01
Individuals considering becoming a living kidney or liver donor.
02
People who have been identified as potential living donors during the organ transplant evaluation process.
03
Eligible donors who want to assess their medical fitness for donation.
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What is Jefferson Health Living Donor Medical Assessment?
Jefferson Health Living Donor Medical Assessment is a comprehensive evaluation process designed to assess the medical suitability of individuals who wish to donate an organ, such as a kidney or part of the liver, to a recipient in need.
Who is required to file Jefferson Health Living Donor Medical Assessment?
Individuals who are considering becoming living organ donors at Jefferson Health are required to file the Jefferson Health Living Donor Medical Assessment to ensure they meet the necessary medical criteria for donation.
How to fill out Jefferson Health Living Donor Medical Assessment?
To fill out the Jefferson Health Living Donor Medical Assessment, prospective donors must complete a detailed questionnaire regarding their medical history, current health status, and any relevant lifestyle factors. This typically involves providing information about medications, personal and family medical histories, and any previous surgeries or health conditions.
What is the purpose of Jefferson Health Living Donor Medical Assessment?
The purpose of the Jefferson Health Living Donor Medical Assessment is to evaluate the potential donor's overall health and ensure that donating an organ will not pose undue risk to their physical well-being while also ensuring the safety of the transplant recipient.
What information must be reported on Jefferson Health Living Donor Medical Assessment?
The information required on the Jefferson Health Living Donor Medical Assessment includes personal identification details, comprehensive medical history, current health conditions, medications being taken, family health history, and any previous surgeries or illnesses that could affect the donation process.
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