DWEB-CMS2A
About Mercy

Refer a Patient

To refer a patient to Mercy Transplant Center:

  1. Print and complete the Transplant Referral Form (fill out completely)
  2. Gather the following documents
  • Demographic page or information
  • Insurance cards (front & back)
  • Most recent history and physical
  • Current medication list
  • Most recent set of labs, include C-Peptide if pancreas referral
  • All diagnostic tests (cardiac, pulmonary, cancer screening, etc)
  • Record of immunizations and TB test
  • For all patients receiving dialysis, also include:
    • 2728 Form and Dialysis Plan of Care
    • 90-day attendance record
    • Social Worker notes

3. Fax referral form and medical records to 515-643-8870


After we receive the referral form and medical records, we will:

  1. Verify the patient’s insurance coverage
  2. Call and schedule the patient for transplant education class
  3. Provide the patient with the required routine health maintenance testing that must be completed prior to transplant evaluation (testing may be completed within the past year or longer depending on the results and recommendations)
  • Dental examination
  • Colonoscopy
  • Mammography
  • Pelvic examination and PAP

Self-Referral

If you are interested in more information about kidney and/or pancreas transplant, or would like to refer yourself for transplant, please call our clinic Monday-Friday between 8:00 am and 4:30 pm at 515-247-4261.

(515) 247-3121
1111 6th Avenue
Des Moines, Iowa 50314

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