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Get and Sign Duke University Lung Transplant Referral Form 2012-2022

Get and Sign Duke University Lung Transplant Referral Form 2012-2022

Create a custom duke lung transplant referral form 2012 that meets your industry’s specifications.

Phone: Gender: M F Race: Relationship: Referring Physician Information Name: Group Name (if applicable): Address: City: State: Office Phone: Zip: Fax: E-mail: Name of Person Completing This Form: Patient Insurance Information (attach copy of both sides of card) Insurance Name: Policyholder’s Name: Policyholder’s DOB: Policy Number: Insurance Phone: Group Number: Secondary Insurance Information (attach copy of both sides of card) Insurance...
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How are you doing this is Cindy Lawrence from the lung transplant program at Duke well we have a lung offer for you, so I would like for you to not eat or drink starting right now, and I need for you to come over to do link transplant is a process it is a journey it requires commitment dedication and likely will be the hardest thing you and your family will do they will task you from top of your head to the bottom of your feet it's an extensive evaluation where we look at your heart your lungs your GI tract as well as your cardiovascular system as a whole we also want to look at the non-medical parts of your body and yourself this includes having you see psychology Social Work finance as well as nutrition and the reasons for this is that to do well with a lung transplant it's not just about your medical condition and your and your hEvalth so once we determine that your then you appear to be a good candidate for a lung transplant we want you to move to Durham, so you can do pulmonary re

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