Data Collection
Dialysis Facilities and Transplant Centers
- ESRD Medical Evidence Report forms (CMS-2728) completed at treatment initiation or re-entitlement
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ESRD Death Notification forms (
CMS-2746)
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- Facility Staffing Update Form
Dialysis Facility Data Tracking Forms
The form below should be completed monthly as part of your internal process of tracking patient activity throughout the year to properly prepare for the annual CMS 2744.