All patients admitted into EQRS with an Admit Reason of 'NEW ESRD' need to have a 2728 (End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration) Form Completed.


  • Admit or Search for patient in EQRS 
    • (you will not find a patient until they have been admitted into your facility in EQRS)
  • Go to Form 2728 on the Left
  • If a 2728 Form is listed in the TOP section, select ADD 2728
  • If a 2728 Form is listed in the BOTTOM section, make sure the DATE SUBMITTED is populated - if not, finish Submitting the 2728 Form
  • Click on Existing 2728 Forms to see the details of the 2728 Form.
    • A patient can have multiple 2728 Forms listed, depending on how often they need to apply for Medicare coverage. 2728 Form types include:
      • Initial 2728: submitted only once after 'New ESRD' admission
      • Supplemental 2728: submitted only if patient starts home modality training within the first 90 days of a 'New ESRD' admission
      • Re-Entitlement 2728: submitted if patient loses Medicare coverage due to:
        • Being off dialysis for >1 year
        • Having a functional kidney transplant for > 3 years


Download detailed CMS Instructions here: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-2728-