Start Your Heart Transplant Application
Your medical records and application to our heart transplant program are more than paperwork. It's your story, our cardiac-specialist team's window into your medical history and the first step toward determining which advanced heart failure therapies, including heart transplantation, will work best for you. 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 heart treatment plan for you. 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 make sure you're a candidate for heart transplant and we can't accept your application without them.
Send the following medical records along with your completed application form:
- Cardiologist's history and physical (typed copy)
- Current office notes/progress notes from your cardiologist's office
- Recent labs from your cardiologist's or primary physician's office
- Copies of insurance cards and drug coverage cards (front and back)
- Completed insurance Information sheet (page 4 on application)
- Pathology reports and treatment records for any patient with a history of cancer
- Cardiac catheterization results (if done)
- Echocardiogram results
- Chest x-ray and/or CAT scans (if done)
Send In Your Application
Mail or fax your completed application and medical records to:
Florida Hospital Transplant Institute
2415 N. Orange Ave, Suite 700
Orlando, FL 32804
We know waiting isn't easy. But we hope it helps to know that once we receive your medical records, your information is in good hands and your well-being is on our minds. Your medical care team will carefully review your application and medical records to see if you meet our program's heart transplant requirements. Once it's reviewed, your financial coordinator will work with you and your caregiver to help you understand what medical and medication coverage is available to you. The second we get the green light, we'll be in touch to help you take the next step: Evaluation.