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Kidney Transplant Clinic - Referrals

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​​​​​​​​​​Referral​​​

To complete the standard referral process, complete our online referral form

  • At the bottom of the form you will be asked to type in a code for verification. Once submitted a confirmation message will be sent back to your office saying that we received your referral.
  • Our assessment office will notify you upon receipt of the referral. A transplant assessment coordinator will call to review your patient’s health issues and the evaluation process. We will let you know when we have scheduled the patient’s first appointment.

​​Checklist for a Complete Referral​​​

In addition to the completed referral form, make sure to include all required tests:

Serologies

  • Varicella Zoster lgG
  • CMV
  • EBV
  • HCV
  • HIV 1&2
  • HTLV 1&2
  • HBsAg
  • HBsAb
  • HBcAB
  • Syphilis

Imaging

  • Chest X-ray
  • Abdominal U/S

Cardiovascular Assessments

  • 2D Echocardiogram
  • ECG
  • Stress Echo or Myocardial Perfusion Scan

According to Cancer Care Ontario guidelines

  • Mammograms
  • Pap smear
  • Colon

In addition, the following information may be helpful in the evaluation process:

  1. Complete Medical History
  2. Letter of referral
  3. Copy of medication record
  4. Glucose tolerance test (all non-diabetics)
  5. Copy of hepatitis immunization
  6. Copy of most recent routine blood work (incl. Liver function and lipid profile)
  7. TB skin test
  8. All medical consults

If this information is not included with the referral form, your referral may be returned as incomplete.

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More Referral Links

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Go to the Kidney Transplant Clinic