Physician Referral Form
To refer a patient for transplant, please complete referral form for your patient and fax to 504-842-3343 with all pertinent records necessary to expedite your referral. Call 504-842-3925 with questions.
- Completed Referral Form
- Patient Demographic Sheet
- Copy of insurance cards front and back
- Complete History & Physical (within 1 year of referral date)
- Medicare Form 2728 (if on dialysis), patient cannot be listed without this
- Medication List
- Lab results/TB skin test (within 1 year of referral date)
- PTH < 1000 to be considered for transplant
The Ochsner Multi-Organ Transplant Institute provides consistent follow-up information to all referring physicians regarding each patient they direct to our care. Follow-up information is communicated in writing as well as by phone after a patient's transplant.
All patients are eventually returned to the care of their referring/primary care physicians, with periodic follow-up visits to Ochsner. The transplant team continues to monitor for transplant-related complications and regulates maintenance immunosuppression.