Get Uc Davis Kidney Transplant Referral Form

Completing the Uc Davis Kidney Transplant Referral Form online ensures that the necessary information is accurately submitted for potential kidney transplantation. This guide provides a step-by-step approach to filling out each section of the form effectively.

Follow the steps to successfully complete your referral form.

1. Press the ‘Get Form’ button to access the referral form and open it for editing.
2. Begin by entering the patient's last name and date of birth in the designated fields.
3. In the 'Referral Source' section, check the appropriate box indicating the source of referral, such as Dialysis Unit or Physician’s Office.
4. Fill in the patient's first name, height, and weight in the respective fields.
5. Provide the patient's email address for further communication and support.
6. Enter the referring nephrologist's name, phone number, address, and fax number accurately.
7. Similarly, identify the current primary care provider (PCP) by providing their name, phone number, and address.
8. Specify any special considerations for the patient, such as the need for an interpreter, disabilities, or other relevant information.
9. Indicate whether there is a possible living kidney donor, marking either 'Yes' or 'No.' If 'Yes,' use the provided resources for donor registration.
10. Provide details regarding the patient's dialysis unit, including unit name, phone number, address, and fax number, if applicable.
11. Fill in information related to the type of dialysis the patient undergoes, if any, or provide the lowest recent eGFR if no dialysis is done.
12. Answer the questions regarding contraindications and minimum exercise tolerance, ensuring that the form is completed accurately.
13. Detail any significant medical history, including past or current conditions, and provide necessary documentation if available.
14. Ensure that all required documents, including the demographic sheet and copies of insurance cards, are prepared for submission as directed.
15. Once all fields are filled out correctly, users can save changes, download, print, or share the form as needed.

Complete your Uc Davis Kidney Transplant Referral Form online today to ensure a smooth referral process.