Version 2.77

Status Information


Part Description

LP135356-6   End stage renal disease death notification - OMB CMS form 2746
The ESRD Death Notification (CMS-2746) is completed by all Medicare-approved ESRD facilities to collect fact of death and cause of death of ESRD patients. ESRD Networks must examine the mortality rates of every Medicare approved facility within its area of responsibility. The Death Form provides the necessary data to assist the ESRD Networks to make decisions that result in improved patient care and in cost-effective distribution of resources. The Death Form is also used by health care planning agencies and researchers to determine survival rates by diagnoses. Source: Regenstrief LOINC, CMS 2746

Reference Information

Type Source Reference
Original Form Regenstrief LOINC CMS-2746-U2-ESRD Death Notification Form Link

Panel Hierarchy

Details for each LOINC in Panel LHC-Forms

LOINC Name R/O/C Cardinality Example UCUM Units
68359-9 End Stage Renal Disease (ESRD) Death Notification - OMB CMS form 2746
Indent45394-4 Patient Last (Family) name R
Indent45392-8 Patient First (Given) name R
Indent45393-6 Middle initial R
Indent45397-7 Medicare or comparable number R
Indent46098-0 Sex R
Indent21112-8 Birth date R {mm/dd/yyyy}
Indent45396-9 Social Security number [Identifier] R
Indent46499-0 State of residence R
Indent71480-8 Location of death [ESRD] R
Indent31211-6 Date of death R
Indent68341-7 Modality at time of death R
Indent67878-9 Dialysis facility name R
Indent65833-6 Facility Address R
Indent65833-6 Facility Address
Indent65647-0 City R
Indent68488-6 State location of Facility R
Indent68330-0 Dialysis facility's CMS Certification Number (CCN) where the patient is receiving care R
Indent68343-3 Primary cause? R
Indent68344-1 Were there secondary causes? R
Indent68345-8 If yes, secondary cause of death O
Indent68346-6 If cause is other, please specify O
Indent68347-4 Renal replacement therapy discontinued prior to death? R
Indent68348-2 If yes, check one of the following R
Indent68349-0 Date last dialysis treatment R
Indent68350-8 Was discontinuation renal replacement therapy after patient/family request to stop dialysis? R
Indent68351-6 Date of most recent transplant O
Indent68332-6 Type of donor O
Indent68352-4 Was graft functioning (patient not on dialysis) at time of death? C
Indent68353-2 Did patient resume chronic maintenance dialysis prior to death? C
Indent68354-0 Was patient receiving hospice care prior to death? R
Indent52526-1 Attending physician name R
Indent68995-0 Person completing form name Provider R
Indent68355-7 Date R
Indent65838-5 Date submitted R
Indent68356-5 Form version R

Fully-Specified Name

End stage renal disease death notification - OMB CMS form 2746

Basic Attributes

First Released
Version 2.38
Last Updated
Version 2.50
Panel Type

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