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Get Upmc Lung Transplant Program 2018
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How to fill out the UPMC Lung Transplant Program online
Filling out the UPMC Lung Transplant Program form online is a crucial step in the referral process for lung transplant evaluation. This guide provides detailed instructions to ensure you complete the form accurately and efficiently.
Follow the steps to fill out the form correctly.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out the patient information section. Include the patient’s full name, address, phone number, date of birth, and Social Security Number. Make sure to provide complete details as the referral cannot be processed without a Social Security Number.
- In the referring physician information section, provide the name, address, and phone number of the physician making the referral. Include a fax number and the name of an office contact.
- Complete the primary care physician information. Enter the name of the primary care physician, including their contact details. Also, indicate the patient’s employment status by checking the appropriate box.
- In the insurance information section, ensure all fields are filled correctly. Include the name of the primary insurance, along with the policy and group numbers. Remember to fax copies of the insurance cards, both front and back.
- Next, provide the patient’s height, weight, and smoking cessation data if applicable. Ensure that the emergency contact information is filled out, including their relationship to the patient.
- Outline the patient’s diagnosis and ensure all medical and insurance information is current and accurate. If there is secondary insurance, fill out the relevant details in that section as well.
- Attach all required documents, including results of recent tests for pulmonary function, cardiac evaluations, and any previous transplant evaluations if available.
- Review the entire form for accuracy and completeness before submitting. Finally, save changes, download a copy, or print the completed form for your records.
Complete the UPMC Lung Transplant Program form online today to ensure a smooth referral process.
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Candidates for a lung transplant typically have severe lung disease that significantly impacts their quality of life. The UPMC Lung Transplant Program looks for individuals who show good potential for recovery and adherence to treatment plans. Key factors include your overall health, support systems, and commitment to follow-up care.
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