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Kidney Transplant Patient Referrals to Massachusetts General Hospital
Refer a patient for kidney transplant evaluation at Massachusetts General Hospital. Submit this secure form to connect with our transplant care team.
Please submit the secure form below to refer your patient to a provider in the Kidney Transplant Program at Massachusetts General Hospital. Be sure to submit the following required documents via fax: 617-726-0822.
- 2728 CMS ESRD form (if on chronic dialysis)
- Recent nephrologist visit noteRecent ED discharge summary
- Pertinent test results (e.g., kidney biopsy)
- Insurance information
- Incomplete submissions may result in delays.
To ensure a smooth and expedited intake process please encourage your patient to call registration at 866-211-6588, Monday-Friday, 8:00 am to 5:00 pm ET.