Official Federal Forms
Centers For Medicare And Medicaid Services
Last updated: 3/28/2024
End Stage Renal Disease Medical Evidence Report Medicare Entitlement And-Or Patient Registration {CMS-2728}
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Description
CMS-2728 - END STAGE RENAL DISEASE MEDICAL EVIDENCE REPORT Medicare Entitlement and/or Patient Registration. This form SHOULD NOT be completed for those patients who are in acute renal failure. Acute renal failure is a condition in which kidney function can be expected to recover after a short period of dialysis, i.e., several weeks or months. This form MUST BE completed within 45 days for ALL patients beginning any of the following: Check the appropriate block that identifies the reason for submission of this form. www.FormsWorkflow.com
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