Get Ut Southwestern Kidney Transplant Application

Filling out the UT Southwestern Kidney Transplant Application is a crucial step in the transplant process. This guide provides a comprehensive breakdown of how to complete the application online, ensuring that all necessary information is accurately submitted.

Follow the steps to successfully complete the application online.

1. Click the 'Get Form' button to access the application form and open it in your preferred editor.
2. Begin with the patient information section, where you will input your personal details, including your name, maiden name, Social Security Number (SSN), race, date of birth, gender, and marital status. Ensure that all details are accurate.
3. Provide your contact information, including your address, city, state, zip code, county, and phone numbers. Make sure to indicate your preferred methods of contact.
4. Indicate your citizenship status by selecting 'Yes' or 'No' for both US citizenship and legal residency. If applicable, mention your primary language and driver's license information.
5. Detail any allergies along with their reactions, as well as your current weight and height. Include emergency contact information and their relationship to you.
6. Complete the insurance information section by listing your primary and secondary insurance companies. Include necessary details, such as policy numbers and the insured's information.
7. Fill in your nephrology details, including the name of your nephrologist and the type of dialysis you are undergoing. Specify related information about your dialysis treatments.
8. Respond to questions about previous transplants, kidney biopsies, significant weight changes, and other medical evaluations. Provide thorough responses to medical history inquiries.
9. Sign and date the application, authorizing UT Southwestern to begin the evaluation and financial clearance process. Include any additional required documentation such as insurance cards and medical records.
10. Review your completed application for accuracy, then save changes. You can opt to download, print, or share the completed form as necessary.

Take the next step in your kidney transplant journey by completing your application online today.