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USMC Dialysis Access Referral Form James J. Wynn, Delicias Killer, MDP raise Mathematic, First AvailableName: ___ Date of Referral: ___ DOB: ___SS#: ___Address: ___ City: ___State: ___Zip: ___Home/Cell

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How to fill out ummc dialysis access referral

01

Obtain referral form from the patient's primary care provider.

02

Complete the patient's demographic information on the form.

03

Include medical history, current medications, and any relevant labs or imaging results on the form.

04

Submit the completed form to UMMC's nephrology department for review and scheduling.

Who needs ummc dialysis access referral?

01

Patients with end-stage renal disease requiring dialysis access placement or maintenance.

02

Patients with chronic kidney disease who are being referred for evaluation of potential dialysis access.

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What is ummc dialysis access referral?

UMMC dialysis access referral is a form that must be completed and submitted to request approval for a patient to undergo dialysis treatment at UMMC.

Who is required to file ummc dialysis access referral?

UMMC dialysis access referral must be filed by the referring healthcare provider or the patient's primary care physician.

How to fill out ummc dialysis access referral?

UMMC dialysis access referral can be filled out online on the UMMC website or by contacting the UMMC referral department.

What is the purpose of ummc dialysis access referral?

The purpose of ummc dialysis access referral is to ensure that patients receive the necessary approval and support for dialysis treatment at UMMC.

What information must be reported on ummc dialysis access referral?

UMMC dialysis access referral must include the patient's medical history, current condition, dialysis treatment plan, and any relevant test results.

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