How to Refer Your Patient

University of Utah Health Cardiac Mechanical Support Program

30 N. 1900 E., AC144
Salt Lake City, Utah 84132

Phone: 801-585-5122
Fax: 801-587-8838
Email: MCS Team

We accept referrals via phone 801-585-5122. Our nurse coordinators will help facilitate the initial evaluation. We can assist you in determining if a patient meets criteria for either cardiac transplant or ventricular assist device (VAD) therapy. Our clinical team is available for consultation 24 hours a day. Please call to speak with one of our physicians or clinical coordinators.

Information Needed on Referral

The following information will be requested at the time of referral:

Patient demographics

  • Name,
  • Date of birth
  • Gender
  • Address
  • Phone numbers
  • Insurance information (if applicable)

Patient diagnosis

  • Brief medical history
  • All cardiac related diagnoses
  • Treatments
  • Medications

Referring physician information

  • Name, title
  • Contact numbers
  • Office address