Start Your Liver Transplant Application
Your application to our liver transplant program is more than paperwork. It's your story, our transplant team's window into your medical history and the first step toward finding your liver match. From your first name to your last lab report, every little piece of information you share helps paint a bigger picture that arms us with the knowledge we need to start you on the right path to the right liver. That's why it's so important to cross every "t," dot every "i" and read every word.
Collect Your Medical Records
Just as important as what's written on your application is the following list of medical records. Together with your application, these records help illustrate your journey up until this point. They're essential to helping us move the transplant process forward and we can't accept your application without them.
Send the following medical records along with your completed application form:
- History and physical (typed copy from hepatologist or gastroenterologist)
- Current office notes/progress notes from hepatologist or gastroenterologist)
- Recent labs from hepatologist or gastroenterologist
- Copies of insurance cards and drug coverage cards: front and back
- Completed Insurance Information sheet (page 4 on the application)
- Pathology reports for any patient with a history of cancer
- Pathology reports for any liver biopsy
- Results of viral loads of Hepatitis B and or Hepatitis C
All diabetic patients and all patients older than 50 need to provide the following documents:
- Nuclear Stress Test results within the last 12 months
- Written cardiac clearance for transplant surgery
You'll need to schedule the following tests with your private physicians, but reports aren't required to begin processing your application:
- Colonoscopy is required every 5 years (patients older than 50; send report if available)
- Pap smear and mammogram need to be done annually (females only; send report if available)
Send In Your Application
Mail or fax your completed application and medical records to:
AdventHealth Transplant Institute
2415 N. Orange Ave, Suite 700
Orlando, FL 32804
Fax: 407-303-2998
We know waiting isn't easy. But we hope it helps to know that once we receive your application and medical records, your information is in good hands and your well-being is on our minds. Your transplant nurse coordinator will carefully review your application and medical records to ensure you meet the liver transplant requirements. Once it's approved, we'll forward your records to a financial coordinator for review and approval of insurance and medication coverage. The second we get the green light, we'll be in touch to help you take the next step: Evaluation.