Referral Forms

If you would like to refer your patient to the INTEGRIS Nazih Zuhdi Transplant Institute, please select the appropriate referral form. We also have provided a list of frequently used diagnosis codes and accepted insurances.

• Kidney/Pancreas Referral Form
  Please fax the completed form to 405-815-6404.
• Transplant Evaluation/Hepatology/Hepatobiliary Surgery Referral Form
  Please fax the completed form to 405-713-7643. If you have questions, please call 800-991-3349.
• Lung Referral Form
  Please fax the completed form to 405-552-0450. If you have questions, please call 405-951-8191.
• Advanced and General Gastroenterology Referral Form
  Please fax the completed form to 405-815-6172. If you have questions, please call 405-949-3349.
• Frequently Used Diagnosis Codes
  This is a list of diagnosis codes that are frequently used for transplant patients.
• Accepted Transplant Networks
  Accepted transplant networks at the Nazih Zuhdi Transplant Institute.
• Download Pediatric Gastroenterology Referral Form