To refer a patient to a Tampa General Medical Group (TGMG) specialist, please complete one of the following referral forms below (differs by specialty):
Please fax the requested information detailed within the referral forms to the fax numbers listed at the bottom of the form. To expedite your request, please provide as much information as you can. Should you have any questions or concerns, please do not hesitate to contact the TGMG case managers by calling (813) 844-5507.
If you are interested in being evaluated for transplant, please speak to your physician. Ask your physician to complete a transplant program referral form and fax appropriate medical records to (813) 844-1655.
Click here for the Cardiothoracic Transplant Referral Form.
Click here for the Liver Transplant Referral Form.
Click here for the Kidney and Pancreas Transplant Referral Form.
The Initial Visit
The initial visit is the first step in the transplantation process for eligible patients. During this visit, you will meet a transplant coordinator and the primary physician who will direct your progress through the transplant evaluation process. This visit allows the transplant team members to review your medical history, current medications and answer your questions.
You will be asked to bring any laboratory test results, x-rays, or EKGs and a current list of your medications to this visit. You may eat, drink, and take your medications as usual.
This appointment may take three to four hours. The results may be one of the following:
Your Condition Is Too Early To Be Considered For Transplantation
Further Diagnostic Tests Are Needed To Further Investigate Your Illness. These Tests Can Be Done Through Your Primary Care Physician.
You Have Other Medical Conditions That Do Not Allow Us To Consider You For Transplantation Because Transplant Surgery Would Be More Harmful To You Than Beneficial.
There Are No Absolute Contraindications Noted And Your Condition Warrants A Full Transplant Evaluation In The Near Future. In That Case, The Transplant Physician Will Discuss His/Her Opinion With You Before Your Visit Ends.
The Transplant Evaluation
During this phase of the transplant process, you will go through medical testing, a psychosocial assessment, and consultations with our transplant physicians to see if you are a potential candidate for organ transplantation. This is also a time for you and your family to learn as much about transplantation as possible.
If your condition is stable, your evaluation may be done on an outpatient basis, and you’ll go home at night. During the day, you’ll be assigned a private room in our outpatient clinic. The evaluation usually takes place over three to four days. Each day’s visit will last between 10 and 12 hours. You will be able to rest in your room between tests, and consultations and meals will be provided.
Please do not eat anything after midnight on the day before your appointment. You may drink water. We will take fasting blood samples. The coordinator involved in your evaluation will call you before your appointment and let you know if there are medications that we don’t want you to take. Please feel free to bring something to eat with you to your appointment for after your blood samples are taken.
Your test results will be presented to our transplant medical review board (MRB), which meets once a week. This board, consisting of transplant physicians and specialists, makes the decision about transplant candidates. It is important to note that your assigned transplant coordinator and transplant physician are not assigned to this MRB.
The results may be one of the following:
You Are Too Early To Be Considered For Transplantation.
Diagnostic Tests Are Needed To Further Investigate Your Illness. These Tests Can Be Done Through Your Personal Physician.
You Have Other Medical Or Psychosocial Conditions That Do Not Allow Us To Consider You For Transplantation Because Transplant Surgery Would Be More Harmful To You Than Beneficial.
There Are No Contraindications Noted In Your Evaluation And The Medical Review Board Has Identified You As A Good Candidate For Transplant Surgery. As Soon As Authorization Has Been Obtained From Your Insurance Carrier, You Will Be Placed On The Waiting List.