• If a patient chooses to discontinue dialysis and passes away within 30 days of date of discontinuation, the dialysis facility is responsible for completing the 2746 form.

Enter the date of death and cause of death for the patient in patient attributes page, this will make the 2746 form visible. You will then be able to complete the form.

Complete the CMS-2746 ESRD Death Notification within 14 days of the date of death. If the facility discovers that the patient passed away after 30 days or more from the date of discontinue, enter the Date of Death and Primary Cause of Death on the patient attributes page, but no CMS-2746 Form is required

If the cause of death is not in the field on patient attributes page, the 2746 form does not appear. Enter the cause of death or contact the network via email NW1Help@iproesrdnetwork.freshdesk.com using UPI number.