Transplant Referral Checklist

When referring patients to the Thomas E. Starzl Transplantation Institute, please include the information listed below.

Demographic Summary

  • Patient name
  • Patient date of birth
  • Patient address
  • Patient phone number
  • Emergency contact information (including emergency contact's home and cell phone numbers)

Insurance Information

  • Name of subscriber
  • Subscriber’s relationship to patient
  • Identification number
  • Group number

Clinical Summary

  • Most recent outpatient records
  • Discharge summaries from prior hospitalizations
  • All operative notes, including surgically placed lines
  • Radiologic studies
  • Recent laboratory reports
  • If your patient is currently hospitalized, current hospital records
  • Reports from previous transplant evaluations, including letters of acceptance or decline, if applicable

Referring Physician Information

  • Referring physician name
  • Referring physician phone and fax numbers
  • Primary care physician name

Mailing Address and Contact Information

Mail patient records to:

Thomas E. Starzl Transplantation Institute
UPMC Montefiore, 7 South
3459 Fifth Ave.
Pittsburgh, PA 15213

For more information or to refer a patient:

  • 24-hour physician referral line: 1-800-544-2500
  • Phone: 412-647-5800 or 1-877-640-6746
  • Fax: 412-647-5070
  • E-mail: transplant@upmc.edu

To Refer A Patient

To refer patients for liver transplant evaluations at UPMC’s Thomas E. Starzl Transplantation Institute:

1. Provide all patient and    referring physician information listed on the checklist.

2. Mail demographic and clinical summaries, along with patient records, to the UPMC liver transplant team.

Or, call the 24-hour physician referral line at 1-800-544-2500.

We also accept fax and email referrals. 

Fax: 412-647-5070
Email: transplant@upmc.edu

 

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