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Get TX E-KHC-3 2015-2024

HC will tell you its decision after it does the review. If KHC decides that the trip(s) are related to end-stage renal disease or a kidney transplant, your KHC file will be updated. This will allow you to make future trips related to the condition. For Use By KHC Reviewer ONLY Reviewer: Date: Allow Trip(s): Disallow Trip(s): Comments: E-KHC-3 Page 2 of 2 THIS FORM MAY BE COPIED Rev. 06-2015 .

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