Referral Requirements

The following is a list of the items that are required for a referral to be processed:

• Completed “Evaluation Referral Form” Referral Form PDF
• Recent H&P / Office Visit Note (s)
• Height & Weight
• Copy of the front and back of the patients’ insurance card (s)
• PCP Referral Number on file with patient’s insurance company (Applies to patients with HMO/POS Managed Care Products, and Georgia Better Healthcare only.)
• Long Term Care Plan

Transplant Center