67883-9
Transplant information - end stage renal disease form 2728
Trial
68445-6 Transplant date
Observation ID in Form
CMS-2728_C28
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Date transplant
- Property
- Date
- Time
- Pt
- System
- ^Patient
- Scale
- Qn
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.50
Survey Question
- Text
- Transplant date
- Source
- ESRD.RQMT_259
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 |
Language Variants Get Info
| Tag | Language | Translation |
|---|---|---|
| fr-FR | French (France) | Date transplantation: |
68446-4 Transplant facility name
Observation ID in Form
CMS-2728_C28
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Transplant facility name
- Property
- ID
- Time
- Pt
- System
- Facility
- Scale
- Nom
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.38
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 |
67880-5 Transplant Hospital Federal Provider Number
Observation ID in Form
CMS-2728_C30
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Transplant facility NPI
- Property
- ID
- Time
- Pt
- System
- Facility
- Scale
- Nom
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.44
Survey Question
- Text
- Transplant Hospital Federal Provider Number
- Source
- ESRD.RQMT_262
Normative Answer List LL512-5
- Externally Defined
- Yes
- Code System
- Code System OID
- 1.3.6.1.4.1.12009.10.1.3077
- Link to External List
- https://nppes.cms.hhs.gov/
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 |
68447-2 Date patient was admitted as an inpatient to a hospital in preparation for, or anticipation of, a kidney transplant prior to the date of the actual tranplantation
Observation ID in Form
CMS-2728_C31
Observation Required in Panel
Optional
Fully-Specified Name
- Component
- Date transplant admission
- Property
- TmStp
- Time
- Pt
- System
- ^Patient
- Scale
- Qn
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.44
Survey Question
- Text
- Date patient was admitted as an inpatient to a hospital in preparation for, or anticipation of, a kidney transplant prior to the date of the actual tranplantation
- Source
- ESRD.RQMT_263
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 |
68490-2 Name of Preparation Hospital
Observation ID in Form
CMS-2728_C32
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Transplant preparation facility name
- Property
- ID
- Time
- Pt
- System
- Facility
- Scale
- Nom
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.40
Survey Question
- Text
- Name of Preparation Hospital
- Source
- ESRD.RQMT_265
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 |
68456-3 Medicare provider number for item 32
Observation ID in Form
CMS-2728_C33
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Transplant preparation facility NPI
- Property
- ID
- Time
- Pt
- System
- Facility
- Scale
- Nom
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.44
Survey Question
- Text
- Medicare provider number for item 32
- Source
- ESRD.RQMT_266
Normative Answer List LL512-5
- Externally Defined
- Yes
- Code System
- Code System OID
- 1.3.6.1.4.1.12009.10.1.3077
- Link to External List
- https://nppes.cms.hhs.gov/
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 |
67882-1 Current status of transplant
Observation ID in Form
CMS-2728_C34
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Functional status of transplant
- Property
- Find
- Time
- Pt
- System
- {transplant}
- Scale
- Ord
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.52
Survey Question
- Text
- Current status of transplant
- Source
- ESRD.RQMT_267
Normative Answer List LL1875-5
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Functioning | LA17816-2 | ||
| Non-functioning | LA17817-0 |
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 |
68332-6 Type of donor
Observation ID in Form
CMS-2728_C35
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Donor
- Property
- Type
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.44
Survey Question
- Text
- Type of donor
- Source
- ESRD.RQMT_268
Normative Answer List LL1887-0
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Deceased | LA10939-9 | ||
| Living, related | LA17839-4 | ||
| Living, unrelated | LA17840-2 |
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 |
68333-4 If non-functioning, date of return to regular dialysis
Observation ID in Form
CMS-2728_C36
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Date return to dialysis after failed transplant
- Property
- Date
- Time
- Pt
- System
- ^Patient
- Scale
- Qn
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.50
Survey Question
- Text
- If non-functioning, date of return to regular dialysis
- Source
- ESRD.RQMT_269
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 |
68334-2 Current dialysis treatment site
Observation ID in Form
CMS-2728_C37
Observation Required in Panel
Conditional
Fully-Specified Name
- Component
- Current dialysis treatment site
- Property
- Type
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
Basic Attributes
- Class
- SURVEY.ESRD
- Type
- Surveys
- First Released
- Version 2.38
- Last Updated
- Version 2.44
Survey Question
- Text
- Current dialysis treatment site
- Source
- ESRD.RQMT_270
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 |