Refer a Patient

To initiate the referral process, download and fax the completed appropriate patient referral form and the release of information form to the Hume-Lee Transplant Clinics using the instructions provided on the form.

• Kidney transplant evaluation request form
• Kidney transplant patient questionnaire
• Liver transplant referral form
• Authorization to Release Health Care Information – English
• Authorization to Release Health Care Information – Spanish

In order to facilitate the patient scheduling process, please also fax the patient’s demographics, updated labs, diagnostic images, clinical notes, and complete insurance information when submitting the referral. Once all information has been received, the patient will be contacted by our clinic to schedule an appointment.

If you have any questions or concerns regarding the referral process or a patient you have referred to Hume-Lee, please contact one of our coordinators:

Kidney Transplant Outreach Coordinator
Kim Johnson, MS
(804) 219-7519
Mary.K.Johnson@vcuhealth.org

Liver Transplant Outreach Coordinator
Tierra Yuille
(804) 297-7670
Tierra.Yuille@vcuhealth.org