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Transplant Surgery »  Patient Center »  Kidney Transplant »  New Patient Information and Forms

Transplant Evaluation Appointment for New Patients

Note: This page is for new kidney transplant patients who have a scheduled evaluation appointment.

Instructions

Please complete the required forms below prior to your upcoming evaluation appointment. Please also view the videos and review the patient education materials.

Health History Questionnaire 

Online Medical History Questionnaire (Please complete and submit online)

Required Forms

Please print out and complete these forms. Then bring them with you to your appointment.

English

Authorization for Release of Health Information
Informed Consent To Evaluate
Notice of Privacy Practices and Acknowledgment of Receipt
Questions & Answers for Transplant Candidates about Multiple Listing and Waiting Time Transfer
Terms and Conditions of Service 

Español 

Autorización para la divulgación de información de salud 
Consentimiento informado para evaluarnformed
Aviso de prácticas de privacidad y acuse de recibootice
Preguntas y respuestas para los candidatos de trasplante sobre el listado múltiple y la transferencia del tiempo de esperau
Términos y condiciones de servicio

Videos

Please watch these videos prior to your appointment.

Evaluation

Kidney Transplant Evaluation Video (English)
Video de evaluación de trasplante de riñón (Español)
Kidney Transplant Evaluation Video (廣東話) (Cantonese)
How Organs are Distributed

Living Donor

Living Donor Kidney Video (English)
Vida Video de riñón de donante (Español)
We Are Transplant: Stories from the Novartis Transplant Games
(Patient Stories)
  

Patient Education Materials

Please review these prior to your appointment.

Insurance Information About Your Transplant (English)
Información sobre el seguro de su trasplante
 (Español)
关于你的移植的保险信息
 (中文) (Chinese)
Introduction: Your Health Matters

Notice of Privacy Practices Brochure
Post-Transplant Outcomes Data
Kidney Allocation

Forms of Identification

Please bring these with you to your appointment.

  • Photo ID (REQUIRED)
  • Health Insurance Card  (REQUIRED)

Questions

Please call: (415) 353-1551

UCSF Kidney/Pancreas Transplant Team
Connie Frank Transplant Center
University of California, San Francisco
Kidney/Pancreas Transplant Services
400 Parnassus Ave. 7th Floor, Suite 701
San Francisco, CA 94143-0116

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