Data Training Programs

Data Submission

CMS requires that dialysis providers complete and submit to the Network office the following forms:

  • 2728 - ESRD Medical Evidence Report, Medicare Entitlement and/or Patient Registration -
    Within 45 days of the date of first dialysis
  • 2746 - Death Notification -
    Within 30 days of the date of death
  • 2744 - Annual Facility Survey -
    February each year
  • Patient Activity Report (PAR) -
    By the 10 th day of the month following the reporting month

 

 

 

 

 

 

 

 

 

The Renal Network, Inc.
911 E. 86th Street, Suite 202
Indianapolis, IN 46240
Phone: (317) 257-8265
Fax: (317) 257-8291
Patient Line:
1 (800) 456-6919
Email: info@nw10.esrd.net

Last updated on: March 19, 2009