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Tennessee Kidney Foundation

Empowering and supporting those at risk or affected by kidney disease

Please note TKF’s new mailing address: P.O. Box 330989, Nashville, TN 37203 and shipping address: 1600 Hayes Street, Suite 300, Nashville, TN 37203.

What is Kidney Disease?
Support TKF
- Donate
  - Monthly Giving Campaign
- Volunteer
Get Help
About
- Leadership and Job Opportunities
- Programs
Events
Contact

What is Kidney Disease?
Support TKF
- Donate
  - Monthly Giving Campaign
- Volunteer
Get Help
About
- Leadership and Job Opportunities
- Programs
Events
Contact

Client Status Change Form

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Client Status Change Form

Date*
MM slash DD slash YYYY
Social Worker/Clinic Staff Submitting Form (Name)*
Clinic Name*
Patient Name*
First Name Last Name
Last 4 of Patient SSN*
Please enter a number less than or equal to 9999.
Patient Status Change*
- Death
- Transplant
- Change Clinic
- Change Treatment Modality
- Has new transportation benefit
- No longer eligible for transportation assistance
- Moved out of TKF Service Area
- REFUSED Treatment
Patient Status Change - Other
If none of the above categories apply to your client, please explain here.
Date of Death
MM slash DD slash YYYY
Date of Transplant
MM slash DD slash YYYY
Date Treatment Modality Changed
MM slash DD slash YYYY
Original Treatment Modality
- In Center Memodialysis
- Home Hemodialysis
- CAPD
- CCPD
NEW Treatment Modality
- In Center Memodialysis
- Home Hemodialysis
- CAPD
- CCPD
Date Client REFUSED to Continue Treatment
MM slash DD slash YYYY
Date Transferred to New Clinic
MM slash DD slash YYYY
New Clinic Name

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Sign Up to Volunteer

Screenings Volunteer Signup

Please select the volunteer opportunity you'd like to help with:
- Fundraising (Up Next: Kidney Disease Awareness / Monthly Donor Campaign - March 2021)
- Special Event Volunteer (Up Next: Gala – Saturday, June 19, 2021)
Please provide your preferred screening volunteer assignment:
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Comments
This field is for validation purposes and should be left unchanged.

Lindsey Collier

I volunteer with the TKF because 1 in 3 American adults are at risk for kidney disease and I know the TKF relies on individuals in the community to step-up and freely give their time in order to help sustain its empowering programs for those at risk or affected by kidney disease in our TN communities. I truly believe the volunteer work I do with the TKF is vital to ensuring this marginalized group receives the critical support needed to positively impact their livelihood.

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