Get Uab Kidney Transplant Referral Form

Completing the UAB Kidney Transplant Referral Form accurately is essential for a smooth referral process. This guide provides a step-by-step approach to assist you in filling out all required fields and ensuring timely evaluation of your patient.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the UAB Kidney Transplant Referral Form and open it in your preferred editor.
2. Begin by entering the patient demographics. Include the patient's full name, date of birth, and Social Security Number. This information is crucial for identification and record-keeping.
3. Select the patient's gender and provide additional demographics such as height, weight, and marital status. Ensure these details are accurate as they relate to the patient's health assessment.
4. Indicate the patient's citizenship status by circling one of the options provided: US citizen, non-citizen resident, or non-citizen non-resident. If applicable, include the year of entry into the country.
5. Provide the referring physician's name along with their phone and fax information. This will facilitate communication regarding the patient's referral.
6. Input details about the dialysis unit, including the unit name, phone, and fax numbers, along with the initiation date of dialysis and the days on which the patient undergoes treatment.
7. Address any compliance concerns related to the patient, such as missed treatments or substance abuse, in the designated section. This information helps the evaluation team understand any potential issues.
8. Attach all required medical records, including the history and physical from the past 12 months, insurance card copies, and clinical information such as serologies and medication lists. Ensure all documents are clear and legible.
9. Once all fields are completed and documents attached, save your changes. You may then download, print, or share the completed form as necessary.

Start filling out the UAB Kidney Transplant Referral Form online today to ensure a smooth and efficient referral process.