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                Get Jhh Heart Transplant Program Patient Referral Form
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How to fill out the JHH Heart Transplant Program Patient Referral Form online
The JHH Heart Transplant Program Patient Referral Form is an essential document for referring patients for heart transplant evaluation. This guide provides clear, step-by-step instructions on how to fill out the form online to ensure a smooth and efficient process.
Follow the steps to complete the referral form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
 - Fill in the patient information section. Include the patient’s name, date of birth, address, home phone, and cell or alternate phone number. If applicable, provide the smoking cessation date.
 - Complete the insurance information section. Attach a copy of the patient's insurance card and fill in the details for primary and secondary insurance, including the policy and group numbers.
 - Provide the referring physician's information, including their name, address, phone number, and fax number.
 - Attach any required medical records such as the most recent clinic note, cardiac catheterization results (if performed), the most recent echocardiogram, and any lab work conducted within the past 90 days. Also, include discharge summaries from the most recent hospitalization.
 - Decide how to send the completed referral form and attachments. You can fax the documents to 410-614-9983 or mail them to The Johns Hopkins Heart Transplant Office at 1800 Orleans Street, Blalock 147, Baltimore, MD 21205.
 - If you have questions, you can talk to transplant physicians by calling 410-955-7935 or emailing them directly using the provided email addresses.
 - Once all fields are completed and documents attached, you can save the changes, download, print, or share the form as needed.
 
Complete the JHH Heart Transplant Program Patient Referral Form online today to facilitate timely patient care.
To get on the list for a heart transplant, you first need to undergo a comprehensive evaluation by a transplant center. Begin the process by getting a referral, possibly through the JHH Heart Transplant Program Patient Referral Form. If you meet the medical criteria, the center will guide you through the listing process and ongoing evaluations.
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