2746 Form Instructions

Modified on Tue, Dec 26, 2023 at 6:17 PM

Updated 7/12/2023

The CMS-2746 Form (Death Notification) is required by CMS to be submitted in EQRS within 14 days of the patient's date of death (DOD).

MYTH: A signature is required to submit a 2746 Form

FACT: 2728 Forms require signatures

FACT: 2746 Forms require Cause of Death (COD) and Date of Death (DOD) to be submitted

          - List of CODs below!

MYTH: Facility needs to wait for the death certificate to submit the 2746 Form

FACT: Facility can select 99 / Unknown if they cannot get the information in 14 days

MYTH: Facility cannot know if the patient has died

FACT: Dialysis facility must 'follow' the patient for 30 days after discharge to know their status - especially if patient is hospitalized

If you need to Submit the 2746 but have lost Scope of the patient (gone for more than 30 days):

  1. Find the UPI in EQRS
  2. Go to the Admit page --> Click on the Admit Date --> Delete the Discharge Date & Reason
  3. Return to the Patient Demographics page --> Click Edit
  4. Scroll down to the Medical Info section --> Add Date of Death/Cause of Death
  5. ****The Effective Date needs to be the SAME DATE as the DOD***
  6. Check the Admit page to make sure that the Discharge info reappears
  7. Edit the 2746 - the correct information should now appear

To EDIT a Submitted 2746 Form: https://help.esrd.ipro.org/support/solutions/articles/9000230058-editing-a-submitted-2728-form-2746-form

COVID-19 Codes:

Form 2746 Death Code

ICD 10 Code


Additional Information







COVID19 Unconfirmed



The list of ESRD Death Codes can be found on page 2 of the 2746 Form: 


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