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Thank you for submitting a referral

A representative from the Baystate Health Adult Kidney Transplant Program will contact you. 

Next Step: Send Patient Forms

Now that you have submitted your referral, please fax or email the following information:

1. GFR <20 documentation (if applicable)

2. Form 2728 (if applicable)

3. Documentation of Health Screenings:

  • Colorectal screening if >45 years and <75 years
  • Mammogram within a year of referral for women >45 years – 54 years
  • Mammogram within 2 years of referral for women >55 years
  • Cervical cancer screening for all women between 25-65 years (any of the following)
  • Primary HPV test within 5 years of referral
  • Co-test (HPV and PAP) within 5 years of referral
  • Pap test within 3 years of referral

Email or Fax Documents

If you have any questions, please contact 413-794-2321.