New Patient Referrals: Kidney
Thank you for your interest in the UC Davis Transplant Center. We provide a comprehensive multi-disciplinary approach to all patients and take pride in our innovative care and excellent outcomes.
For your convenience, we have provided a link to our referral form below. Please complete the form and fax it to our Referral Coordinators at 916-734-5194.
To make the most of the evaluation visit, our physicians have asked that we obtain the following records in advance of the visit. We would appreciate it if your staff could fax the records along with the referral form, to help expedite the scheduling of your patient. If your patient has any potential living donors, please have them all come to the visit and our living donor nurse coordinator will see them as well. Again, thank you for your referral, and if you have any questions, please do not hesitate to call our staff at 800-821-9912.
Patient’s most recent H&P
Copy of insurance cards
CMS 2728 form | Fillable PDF
Current medication list
Dialysis lab summary or CMP and CBC within last 6 months
Any radiology or cardiology studies
These forms are fillable PDFs. They can be typed in using PDF software such as Adobe Acrobat Reader.