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  • Emoryhealthcare Mckelvey Lung Transplantation Center Evaluation Referral Form

Get Emoryhealthcare Mckelvey Lung Transplantation Center Evaluation Referral Form

TERM CARE PLAN TO (404) 727-1516. Referring Physician: Phone Number: Referral Date: / / - - Home Phone: ( ) - Work Phone: ( ) - SSN: Patient Name: DOB: First / MI / Age: Last Sex: Race: Street Address: City: State: Zip: Emergency Contact: Relation to Pt: Phone: ( ) - Employer Name: Occupation: Phone: ( ) - Phone: ( ) - Primary Care Physician: County: INSURANCE INFORMATION *Please include a copy of front/back of insurance card(s). Medicare: YES â–¡ NO â–¡ A.

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How to fill out the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form online

Filling out the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form online can streamline the referral process for patients requiring lung transplantation evaluation. This guide provides a step-by-step approach to ensure accurate and efficient completion of the form.

Follow the steps to fill out the form effectively.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Start by entering the referring physician's information, including their name, phone number, and referral date. This section identifies the medical professional making the referral.
  3. Fill out the patient's personal details, including their name, date of birth, age, sex, race, street address, city, state, and zip code. Ensure that all information is accurate as it is crucial for patient identification.
  4. Provide details for the emergency contact, including their relation to the patient and contact phone number.
  5. Enter the patient's employment information, including employer name, occupation, and relevant phone numbers.
  6. Identify the primary care physician's name and the county where the patient resides.
  7. Under insurance information, indicate whether the patient has Medicare and provide details of both primary and secondary insurance, ensuring to include a copy of the front and back of the insurance card(s).
  8. In the medical information section, fill in the patient's diagnosis, height, weight, and pulmonary function test results such as FEV1, VC, and DLCO. This section helps to assess the patient's lung function.
  9. Answer the questions regarding the patient's smoking history, previous chest surgeries, history of coronary artery disease, and the presence of any malignancies. These details are significant for evaluating the patient's medical history.
  10. Lastly, review the completed form for accuracy. You can save changes, download, print, or share the form as needed.

Complete and submit the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form online to facilitate prompt evaluation and care.

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The CPT code for a lung transplant evaluation is typically 32850. This code covers the necessary medical examinations and tests to determine the patient's eligibility for the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form. Ensure your healthcare provider understands this coding for accurate documentation and reimbursement.

The decision on who receives a lung transplant is based on a complex set of criteria that includes medical urgency, compatibility with available donor organs, and overall health status. Each transplant center, including EmoryHealthCare, follows guidelines to ensure fair and equitable access to transplants. By completing the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form, you can initiate the assessment that leads to this critical decision.

Requirements for a lung transplant involve both medical and personal considerations. You typically need a diagnosis of severe lung disease, along with a thorough evaluation by your healthcare team. It is also crucial to show that you can follow medical instructions and attend follow-up appointments. Utilizing the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form helps streamline this process and clarify what is needed.

Getting approved for a lung transplant involves several steps, starting with the evaluation process. You must satisfy specific medical criteria while demonstrating that you can manage post-transplant care. Your medical team will assess your suitability based on various factors, including your lung health and support systems. Submitting the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form is a vital action toward this approval.

A lung transplant evaluation is a comprehensive assessment that determines whether you are a suitable candidate for a transplant. This evaluation examines your overall health, lung function, and other critical factors. By going through this process, you receive essential information that can impact your eligibility. Completing the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form starts this important journey.

The duration of the lung transplant waiting list can vary significantly based on various factors, including your blood type, overall health, and the availability of donor lungs. Generally, patients can expect to wait several months to years. It's important to stay informed, and completing the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form can be a crucial first step in the process.

Criteria for getting a lung transplant generally include the severity of lung disease, overall health status, and psychosocial factors. You'll need to demonstrate that you can adhere to post-transplant care and lifestyle changes. The EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form outlines these criteria to help you assess your situation.

Not being a candidate for lung transplant often results from having severe comorbidities or factors that may complicate surgery and recovery. Uncontrolled diabetes, active malignancies, or severe heart disease can disqualify you. Understanding these factors through the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form can provide clarity.

Indications for lung transplant referral and listing include the presence of end-stage lung disease with limited treatment options. Patients with conditions like severe emphysema or pulmonary fibrosis often qualify for evaluation. Ensuring you have the right documentation through the EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form can facilitate this process.

Referral to a lung transplant team is recommended when conventional therapies no longer manage your lung disease effectively. Symptoms such as increased breathlessness, frequent exacerbations, or declining functional status may signal the need for referral. The EmoryHealthCare McKelvey Lung Transplantation Center Evaluation Referral Form can help you know when the right timing is.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232