Heart-Lung and Lung Transplant Program

• Patient Referral Form
• Patient phone number, address, and Social Security Number
• Insurance information
• History and physical, clinic notes, or hospital discharge summary
• Pulmonary function studies
• X-ray report
• Thoracic CT scan report (if performed)
• Chemistry panel
• Hematology panel
• Sputum cultures and sensitivities for patients with cystic fibrosis or bronchiectasis
• Copy(s) of heart catheterization report(s) if performed

Adult Cystic Fibrosis Program

• Patient Referral Form
• History and physical notes, including clinic or office notes and current medications
• Hospital discharge if in last two years
• Recent PFT or spirometry
• Recent Sputum cultures and sensitivities
• Recent CT scan

Interstitial Lung Disease Program

• Patient Referral Form
• Most recent Pulmonary Function Tests (breathing tests)
• CDs of recent high resolution CT scan of the chest, any other recent CT scans
• Any lung biopsy reports, including slides
• Recent lab work, including any serology testing done to identify autoimmune disease
• Recent history, office visit, and physical notes from local pulmonologist or primary care provider
• Echocardiogram
• Current list of medications
• Discharge summary from any recent hospitalizations
• Six Minute Walk or other oxygen exercise testing