Get Jhh Lung Transplant Program Patient Referral Form
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How to fill out the JHH Lung Transplant Program Patient Referral Form online
Filling out the JHH Lung Transplant Program Patient Referral Form online is an essential step in referring a patient for evaluation and treatment. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to successfully complete the referral form.
- Press the ‘Get Form’ button to access the form and open it for editing.
- Begin with the patient information section. Enter the patient's diagnosis, full name, date of birth, address, home phone, and cell or alternate phone number. Include the smoking cessation date if applicable.
- In the insurance information section, attach a copy of the patient's insurance card. Enter the primary insurance name and phone number, followed by the policy and group numbers. If applicable, provide the same information for secondary insurance.
- Complete the referring physician information section with the physician's name, address, phone number, and fax number.
- Prepare to attach the required medical records. Specify the attachments, including the most recent pulmonary function tests, radiologic studies (chest CT or X-ray), lung echocardiogram, cardiovascular catheterization reports, relevant pathology reports, and any lab work conducted within the past 90 days.
- Include discharge summaries from the most recent hospitalization along with the referral letter.
- Send the completed form and attached documents either by fax to 410-614-7008 or by mail to The Johns Hopkins Comprehensive Transplant Center at 720 Rutland Ave., Ross 771, Baltimore, MD 21205.
- If there is a need for further discussion, you can contact the office at 410-614-4898 or directly email the designated transplant physicians.
- After submitting, await confirmation of insurance in-network status, and educational literature on lung transplantation will be mailed to the patient.
Start the patient referral process by filling out the JHH Lung Transplant Program Patient Referral Form online today.
To write a proper referral, include essential patient information, the referring physician's details, and a clear explanation of the patient's condition. Be direct about the purpose of the referral and specify any pertinent medical history or test results. This approach ensures that the JHH Lung Transplant Program team receives all necessary information to make informed decisions.
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