Get the free Lung Transplant Referral Form - NET

Contact for Questions or aAssistanceLung Transplant Referral FormCristy McCartney Transplant Administrative Specialist 101 Manning Drive Chapel Hill, NC, 27514 Cristy.McCartney@unchealth.unc.eduThank

How to fill out lung transplant referral form

How to fill out lung transplant referral form

1. Obtain the lung transplant referral form from the transplant center or online.
2. Fill out your personal information including name, contact information, and date of birth.
3. Provide detailed medical history including your diagnosis, previous treatments, and current medications.
4. Include relevant test results such as lung function tests, imaging scans, and blood work.
5. Have your healthcare provider complete their section of the form and provide any additional comments or recommendations.
6. Submit the completed form to the transplant center either in person, by mail, or online.

Who needs lung transplant referral form?

1. Individuals with end-stage lung disease who have been evaluated by their healthcare provider and determined to be potential candidates for a lung transplant.

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What is lung transplant referral form?

The lung transplant referral form is a document used to refer patients for evaluation to determine their eligibility for a lung transplant.

Who is required to file lung transplant referral form?

Healthcare providers, including physicians and specialists, are required to file the lung transplant referral form on behalf of their patients.

How to fill out lung transplant referral form?

To fill out the lung transplant referral form, providers should enter patient demographics, medical history, current health status, and relevant diagnostic test results as required by the transplant center.

What is the purpose of lung transplant referral form?

The purpose of the lung transplant referral form is to initiate the evaluation process for patients who may benefit from a lung transplant and ensure the appropriate information is provided to the transplant team.

What information must be reported on lung transplant referral form?

The lung transplant referral form must report personal information, medical history, current treatments, and results of lung function tests among other clinical data.