Please include these items when sending a referral:
Copy of all Insurance Cards (front and back)
- History and Physical (must be within 1 year of referral date)
- Patient information (demographic sheet)
- Signed Release of Information Form
For Transplant Referral also include:
- Latest lab results (must be within 1 year of referral date)
- Medication list
- Dental clearance letter
- Previous cardiac testing (EKG, Stress Test, ECHO, Cath, Chest X-ray…)
- Pap smear and mammogram for women over the age of 40 (most recent if strong family history)
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