Lung Transplant Referral Form

Upon receiving the the information and records below, we will verify evaluation eligibility and send you a letter outlining our decision. If eligible, we will contact the patient to discuss details about the process and to begin scheduling the evaluation.

When the evaluation has been completed, we will inform you of the results of your patient’s testing and our recommendations regarding his/her suitability for lung transplant.

Should you have any questions throughout this process or thereafter, please do not hesitate to contact our office at 314.362.5378.

Patient Information

Insurance Information

Primary Insurance

Secondary Insurance

Referring Physician Information

Primary Care Physician

Requested Records

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General Information: 314.747.3000
One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110
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