Get Upmc Lung Transplant Program 2019-2026
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How to fill out the UPMC Lung Transplant Program online
Completing the UPMC Lung Transplant Program referral form is a crucial step in initiating the assessment for lung transplant eligibility. This guide will provide you with clear instructions on how to accurately fill out the form online, ensuring that all necessary information is included for a smooth processing experience.
Follow the steps to complete your referral form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out the Patient Information section. This includes the patient's name, address, date of birth, gender, race/ethnicity, and Social Security Number (SSN). Ensure that the SSN is accurately provided, as the referral cannot be processed without it.
- Next, include details about the Referring Physician. Fill in the physician's name, address, phone number, and fax number. It is also essential to list the office contact name for follow-up purposes.
- In the Primary Care Physician Information section, enter the primary care physician’s name, as well as their contact number and office details.
- Complete the Employment and Insurance Information sections. Indicate the employment status while providing details about the employer if applicable. Fill out the primary insurance details comprehensively and ensure to include the policy number and group number.
- Provide the patient’s home and cell phone numbers, email address, marital status, height, weight, and any relevant smoking cessation data. If the patient has an emergency contact, include their relationship and contact number.
- Attach the necessary documentation as outlined in the form. This includes test results for pulmonary function, arterial blood gases, cardiac evaluations, and the most recent CT scan. Make sure all attachments are up to date.
- Once you have filled out all the sections thoroughly, review the form for accuracy. After ensuring that all fields are complete, you can save changes, download, or print the form for submission.
- Finally, fax or e-fax the completed form and attached documents to 412-864-5913 to initiate the referral process.
Complete your UPMC Lung Transplant Program referral form online today to start the evaluation process.
Approval for a lung transplant at the UPMC Lung Transplant Program is a structured process that requires thorough medical evaluations. Your healthcare team will review your overall health, lung function, and any competing medical issues. After assessments, a transplant committee will decide on your eligibility, taking into account your potential for a successful outcome. Staying informed and engaged with your treatment plan enhances your chance of receiving approval.