Get Emoryhealthcare Mckelvey Lung Transplantation Center Evaluation Referral Form
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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.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- 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.
- 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.
- Provide details for the emergency contact, including their relation to the patient and contact phone number.
- Enter the patient's employment information, including employer name, occupation, and relevant phone numbers.
- Identify the primary care physician's name and the county where the patient resides.
- 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).
- 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.
- 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.
- 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.
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.
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