Start Your Kidney Application
Your application to our kidney 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 kidney 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 kidney. 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 process your application without them.
Send the following medical records along with your completed application form:
- Nephrologist's History and physical (typed copy)
- Current office notes/progress notes from nephrologist
- Dialysis Social Worker Initial Evaluation (only if you have already begun dialysis)
- Copy of ESRD Form 2728 (for patients on dialysis; dialysis center will have copy)
- Recent labs from dialysis center or nephrologist's office
- Copies of Driver's License, 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
- Colonoscopy results (ALL patients 50 years and older)
- Pap Smear results (ALL female patients 18 years and older)
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 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 kidney 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.