Version 2.80

68335-9 Self-dialysis training facility name Dialysis facility

Observation ID in Form

CMS-2728_D38

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Self-dialysis training facility name
Property
ID
Time
Pt
System
Dialysis facility
Scale
Nom
Method

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
67868-0 End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

67881-3 Self-dialysis Training Facility Federal Provider Number

Observation ID in Form

CMS-2728_D39

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Self-dialysis training facility NPI
Property
ID
Time
Pt
System
Dialysis facility
Scale
Nom
Method

Long Common Name

Self-dialysis training facility NPI Dialysis facility

Basic Attributes

Class
SURVEY.ESRD
Type
Surveys
First Released
Version 2.38
Last Updated
Version 2.40 (MIN)

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

68362-3 Date training began.

Observation ID in Form

CMS-2728_D40

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Date self-dialysis training began
Property
Date
Time
Pt
System
^Patient
Scale
Qn
Method

Long Common Name

Date self-dialysis training 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

68336-7 Type of training

Observation ID in Form

CMS-2728_D41a

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Self-dialysis training
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Self-dialysis training

Basic Attributes

Class
SURVEY.ESRD
Type
Surveys
First Released
Version 2.38
Last Updated
Version 2.44 (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

68337-5 Location of training

Observation ID in Form

CMS-2728_D41b

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Self-dialysis training
Property
Loc
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Self-dialysis training location

Basic Attributes

Class
SURVEY.ESRD
Type
Surveys
First Released
Version 2.38
Last Updated
Version 2.44 (MIN)

Normative Answer List LL1888-8

Answer Code Score Answer ID
Home LA14084-0
In center LA17841-0

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

68338-3 This patient is expected to complete training and will self-dialyze on a regualr basis

Observation ID in Form

CMS-2728_D42

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Is patient expected to complete training
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Is patient expected to complete training

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

68339-1 Date when patient completed, or is expected to complete training

Observation ID in Form

CMS-2728_D43

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Date self-dialysis training completion
Property
Date
Time
Pt
System
^Patient
Scale
Qn
Method

Long Common Name

Date self-dialysis training completion

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

68491-0 Training Physician Name

Observation ID in Form

CMS-2728_D44a

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Self-dialysis training physician name
Property
Pn
Time
Pt
System
Provider
Scale
Nom
Method

Long Common Name

Self-dialysis training physician name Provider

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
67868-0 End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

68355-7 Date

Observation ID in Form

CMS-2728_D44b

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Date signed
Property
TmStp
Time
Pt
System
Form
Scale
Qn
Method

Long Common Name

Date signed

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
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

68357-3 Self-dialysis training physician NPI Provider

Observation ID in Form

CMS-2728_D45

Observation Required in Panel

Conditional

Fully-Specified Name

Component
Self-dialysis training physician NPI
Property
ID
Time
Pt
System
Provider
Scale
Nom
Method

Basic Attributes

Class
SURVEY.ESRD
Type
Surveys
First Released
Version 2.38
Last Updated
Version 2.44 (MIN)

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