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Living Donation

​Transplant Referral Checklist

Demographic Summary

  • ​Patient name
  • Patient date of birth
  • Patient address
  • Patient phone number
  • Emergency contact information (including emergency contact's home and cell phone numbers)

Insurance Information

  • ​Name of subscriber
  • Subscriber’s relationship to patient
  • Identification number
  • Group number

Clinical Summary

  • ​Most recent outpatient records
  • Discharge summaries from prior hospitalizations
  • All operative notes, including surgically placed lines
  • Radiologic studies
  • Recent laboratory reports
  • If your patient is currently hospitalized, current hospital records
  • Reports from previous transplant evaluations, including letters of acceptance or decline, if applicable

Referring Physician Information

  • Referring physician name
  • Referring physician phone and fax numbers
  • Primary care physician name

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For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

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Medical information made available on is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

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