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* 1. Referring Physician Name

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* 2. Referring Physician Email

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* 3. Clinic Information

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* 4. Patient Name

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* 5. Patient Date of Birth

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For an urgent referral or emergent transfer of your patient to Baptist Memorial Hospital-Memphis to evaluate for Advanced Heart Failure Therapies, call 901-226-LVAD. If your patient currently has a Mechanical Assist Device, call 901-226-LVAD.

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