We accept referrals via phone 801-581-6795. Susan Osborne, our transplant assistant, will help facilitate the initial evaluation.
Liver Transplant Assistant
Toll-free: 800-824-2073 Extension 16795
Patient Information Needed
The following information, if available, will be requested at the time of referral:
- Patient demographics, including current insurance information
- Two years of medical records from all attending physicians and specialists
- History and physical
- Lab work
- Radiology reports
- Pathology report, including liver biopsy if available
- Surgery and procedure reports, including EGD, Colonoscopy, pap smear, and mammogram, if applicable
- If there is a history of drug or alcohol abuse, the patient will need to provide documentation of six months of attendance in a relapse prevention program, such as alcoholics anonymous, or private inpatient or outpatient treatment and results of six months of random drug and alcohol screens from referring physicians.
- Immunization records
- A letter from your dentist stating that all dental work has been completed and that no further dental treatment, other than teeth cleaning, should be required for one year.