Though your actual liver transplantation will take place at a Transplant Facility (i.e. Houston, Nashville, Pittsburgh, Portland, Madison, or Richmond), a significant portion of your care and monitoring will still take place at your local hospital. Much of your initial work-up and pre-treatment monitoring will take place at your local facility. Your local facility will also take part in the care of your liver long after your liver transplant.

It is important for you to familiarize yourself with your facility and those that are caring for you, from your primary care doctor to your hepatologist and liver transplant coordinator (if he or she is at your facility and not at the transplant facility).

Use the sections below to keep track of this information.

My Local Facility Name: _____________________________

My Local Facility Phone Number: ______________________

My Gastroenterology Department Phone Number: ________

My Primary Care Provider:

Dr. ____________________________________________

Ph #: __________________________________________

Email: _________________________________________

My Hepatologist:

Dr. ____________________________________________

Ph #: __________________________________________

Email: _________________________________________

My Transplant Coordinator:

Dr. ____________________________________________

OR

Nurse ____________________________________________

Ph #: __________________________________________

Email: _________________________________________

Your local facility may have a support group set up for patients, who like you, are a part of the transplant process, either planning to have a transplant, or have had one already. These groups are very useful and are there to provide you with an extra layer of support. If your facility has a support group, please write down that information below. A facilitator is the person leading the group, and the coordinator is usually the person who handles the set up and day-to-day operations for your group. It may also be useful for you to jot down the names of few support group members that you can turn to if you have questions or concerns.

My Support Group Facilitator:

__________________________________________________

Ph #: __________________________________________

Email: _________________________________________

My Support Group Coordinator:

__________________________________________________

Ph #: __________________________________________

Email: _________________________________________

Name of Support Group Member (1):

__________________________________________________

Ph #: __________________________________________

Email: _________________________________________

Name of Support Group Member (2):

__________________________________________________

Ph #: __________________________________________

Email: _________________________________________

For some patients, hepatitis C is a cause for their need to have a new liver. If this is the case for you, it may be helpful to know who at your facility can help you manage your hepatitis C, or that manages hepatitis C support groups. (Please keep in mind that some facilities may not have a hepatitis C coordinator.)

My Hepatitis C Coordinator:

__________________________________________________

Ph #: __________________________________________

Email: _________________________________________