Get the free Lung Transplant Referral Form - MUSC Health

MedicalUniversityofSouthCarolinaLungTransplantProgramReferralForm Pleaseprintandcompletethisforminfullbeforefaxingitto8437927845. Oncewereceiveit, wewillcontactyourpatienttoscheduleaninitialclinicvisit,

How to fill out lung transplant referral form

How to fill out a lung transplant referral form:

1. Begin by gathering all necessary information. This may include personal details such as your full name, date of birth, address, and contact information.
2. Next, provide your medical history. Include any relevant diagnoses, previous surgeries, and medications you are currently taking. It is important to be thorough and accurate in this section to ensure the medical team has a comprehensive understanding of your condition.
3. Include any additional documents or tests that support your need for a lung transplant. This may include pulmonary function tests, chest X-rays, or CT scans. These documents provide valuable information for the transplant evaluation process.
4. Indicate any potential living donors. If you have identified someone who is willing to be evaluated as a living donor for a lung transplant, include their contact information and relationship to you on the form.
5. Provide a summary of your current lung condition. This should include information regarding your lung disease, its severity, and how it is impacting your daily life. It is important to provide as much detail as possible to assist the transplant team in assessing the urgency and eligibility for a transplant.

Who needs a lung transplant referral form:

1. Individuals who have been diagnosed with end-stage lung disease may need a lung transplant referral form. This includes conditions such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, and bronchiectasis.
2. Patients whose lung function has significantly deteriorated, despite optimal medical management and treatment, may require a referral for a lung transplant evaluation.
3. Individuals who are experiencing a decline in their quality of life due to respiratory symptoms and are not seeing improvement with other treatment options may be candidates for a lung transplant referral.

It is important to note that the decision to pursue a lung transplant is typically made in collaboration with a healthcare provider, who can assess the individual's specific medical condition and discuss potential treatment options.

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What is lung transplant referral form?

A lung transplant referral form is a document used to refer a patient to a lung transplant center for evaluation and possible transplant surgery.

Who is required to file lung transplant referral form?

The patient's primary care physician or pulmonologist is typically required to file the lung transplant referral form.

How to fill out lung transplant referral form?

The form usually requires the patient's medical history, test results, and information about their current lung condition to be filled out.

What is the purpose of lung transplant referral form?

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

What information must be reported on lung transplant referral form?

The form may require information such as the patient's demographics, medical history, current lung function, and any previous treatments.