67877-1
End stage renal disease (ESRD) patients in dialysis treatment - end stage renal disease form 2728
Trial
67878-9 Dialysis facility name
Observation ID in Form
CMS-2728_B20
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Facility name
- Property
- ID
- Time
- Pt
- System
- Dialysis facility
- Scale
- Nom
- Method
Long Common Name
Facility name Dialysis facility
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.40 (MIN)
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 68359-9 | End Stage Renal Disease (ESRD) Death Notification - OMB CMS form 2746 |
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
| 71747-0 | Facility panel [ESRD] |
68330-0 Dialysis facility's CMS Certification Number (CCN) where the patient is receiving care
Observation ID in Form
CMS-2728_B21
Observation Required in Panel
Required
Fully-Specified Name
- Component
- CMS certification number - CCN
- Property
- ID
- Time
- Pt
- System
- Dialysis facility
- Scale
- Nom
- Method
Long Common Name
CMS certification number - CCN Dialysis facility
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.40 (MIN)
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 68359-9 | End Stage Renal Disease (ESRD) Death Notification - OMB CMS form 2746 |
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
| 71747-0 | Facility panel [ESRD] |
68442-3 Primary dialysis setting
Observation ID in Form
CMS-2728_B22
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Dialysis setting.primary
- Property
- Type
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.40 (MIN)
Normative Answer List LL1886-2
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Home | LA14084-0 | ||
| Dialysis facility/center | LA17837-8 | ||
| Skilled nursing facility (SNF)/Long term care | LA17838-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
68443-1 Primary type of dialysis
Observation ID in Form
CMS-2728_B23
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Dialysis.primary
- Property
- Type
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
Long Common Name
Primary dialysis
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.40 (MIN)
Normative Answer List LL1874-8
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Hemodialysis | LA9975-9 | ||
| Continuous ambulatory peritoneal dialysis (CAPD) | LA17814-7 | ||
| Continuous cycling peritoneal dialysis (CCPD) | LA17815-4 | ||
| Other | LA46-8 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
68448-0 Sessions per Week
Observation ID in Form
CMS-2728_B23a
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Dialysis sessions per W
- Property
- NRat
- Time
- Pt
- System
- ^Patient
- Scale
- Qn
- Method
Long Common Name
Dialysis sessions per week
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.48 (MIN)
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
Example Units
| Unit | Source |
|---|---|
| {#}/wk | Example UCUM Units |
68489-4 Hours per session
Observation ID in Form
CMS-2728_B23b
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Dialysis Hs per session
- Property
- NRat
- Time
- Pt
- System
- ^Patient
- Scale
- Qn
- Method
Long Common Name
Dialysis hours per session
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.48 (MIN)
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
Example Units
| Unit | Source |
|---|---|
| h/{session} | Example UCUM Units |
68358-1 Date regular chronic dialysis began
Observation ID in Form
CMS-2728_B24
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Date chronic dialysis began
- Property
- Date
- Time
- Pt
- System
- ^Patient
- Scale
- Qn
- Method
Long Common Name
Date chronic dialysis began
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.50 (MIN)
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
68444-9 Date patient started chronic dialysis at current facility
Observation ID in Form
CMS-2728_B25
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Date chronic dialysis began at current facility
- Property
- Date
- Time
- Pt
- System
- ^Patient
- Scale
- Qn
- Method
Long Common Name
Date chronic dialysis began at current facility
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.50 (MIN)
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
68360-7 Has patient been informed of kidney transplant options?
Observation ID in Form
CMS-2728_B26
Observation Required in Panel
Required
Fully-Specified Name
- Component
- Transplant options given to patient
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Ord
- Method
Long Common Name
Transplant options given
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.44 (MIN)
Normative Answer List LL361-7
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | LA33-6 | ||
| No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) | LA32-8 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
68361-5 If patient NOT informed of transplant options, please check all that apply.
Observation ID in Form
CMS-2728_B27
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Reasons patient not informed of transplant option
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
Long Common Name
Reasons patient not informed of transplant option
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.44 (MIN)
Normative Answer List LL1884-7
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Medically unfit | LA17830-3 | ||
| Unsuitable due to age | LA17831-1 | ||
| Psychologically unfit | LA17832-9 | ||
| Patient declines information | LA17833-7 | ||
| Patient has not been assessed | LA17834-5 | ||
| Other | LA46-8 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 67868-0 | End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728 |