CROWNWeb Release Documents

Updated January 20, 2015 for CROWNWeb Version 4.7

Kidney Data Definitions
Location KDD ID Display Name Definition CR Reference
ClinicalRQMT_794Display PatientsIndicates the selection of patients with data or missing all clinical data to be identified. 
ClinicalRQMT_1518No Clinical Data AvailableAllow the user to select when the patient does not have clinical data. 
Clinical ModuleRQMT_316Phosphorus DateIndicates the date of phosphorus value.RQMT_1425
Clinical ModuleRQMT_1465Phosphorus (mg/dL)Indicates the pre-dialysis plasma, serum, or Unable to be Determined (UTD) phosphorus value.RQMT_1425
Clinical ModuleRQMT_1557Phosphorus MethodIndicates the method for collection of Phosphorus.RQMT_1425
Clinical Module / Adequacy of DialysisRQMT_322Kt/V DateIndicates the collection date of Single Pool Kt/V value. 
Clinical Module / Adequacy of DialysisRQMT_326V MethodIndicates the method by which V was calculated for Kt / V Peritoneal Dialysis. 
Clinical Module / Adequacy of DialysisRQMT_339BlankIndicates the patient's height unit of measure. 
Clinical Module / Adequacy of DialysisRQMT_341BlankIndicates the unit of measurement used for clinic weight. 
Clinical Module / Adequacy of DialysisRQMT_746BlankMethod used to calculate Creatinine Clearance for Peritoneal Dialysis Collection Type. 
Clinical Module / Adequacy of DialysisRQMT_1267Kt / VIndicates the Kt / V urea (dialysate and urine clearance) at the time the Kt / V PD adequacy measurement was performed. 
Clinical Module / Adequacy of DialysisRQMT_1339Serum Creatinine (mg/dL)Indicates the serum creatinine value (mg/dl) for this patient. 
Clinical Module / Adequacy of DialysisRQMT_1340BlankIndicates the date the serum creatinine value was collected for the patient. 
Clinical Module / Adequacy of DialysisRQMT_1464Kt/V MethodIndicates the method used to calculate Single Pool Kt/V for Kt/V Hemodialysis. 
Clinical Module / Adequacy of DialysisRQMT_1493Body Surface Area (BSA) MethodIndicates the method by which Body Surface Area was calculated. 
Clinical Module / Adequacy of DialysisRQMT_1494RRF Assessed in Kt/VIndicates whether the standard process of assessing Residual Renal Function was performed when calculating the Kt/V. 
Clinical Module / Adequacy of DialysisRQMT_1495Clinic WeightIndicates the patient's weight at clinic visit (abdomen empty) at the time the PD adequacy measurement was performed. 
Clinical Module / Adequacy of DialysisRQMT_1496Kt/V DateIndicates the date when PD adequacy measurement was performed. 
Clinical Module / Adequacy of DialysisRQMT_1497Creatinine ClearanceIndicates the creatinine clearance (dialysate and urine clearance) at the time the PD adequacy measurement was performed; also used to calculate the GFR. 
Clinical Module / Adequacy of DialysisRQMT_150024hr Urine Volume (mL)Indicates the 24 hr urine volume, if performed, at the time the PD adequacy measurement was performed. 
Clinical Module / Adequacy of DialysisRQMT_1514Kt/VIndicates the Single Pool Kt/V value for Hemodialysis. 
Clinical Module / Adequacy of DialysisRQMT_1515Blood Urea Nitrogen (BUN) Pre-Dialysis (mg/dL)Indicates the pre-dialysis Blood Urea Nitrogen (BUN) value. 
Clinical Module / Adequacy of DialysisRQMT_1516Normalized Protein Catabolic (nPCR) RateIndicates patient's Normalized Protein Catabolic Rate 
Clinical Module / Adequacy of DialysisRQMT_1517BlankIndicates patient's Normalized Protein Catabolic Rate Collection Date 
Clinical Module / Adequacy of DialysisRQMT_1531Blood Urea Nitrogen (BUN) Pre-Dialysis (mg/dL)Indicates the pre-dialysis Blood Urea Nitrogen (BUN) value. 
Clinical Module / Adequacy of DialysisRQMT_1532Pre-Dialysis WeightIndicates pre-dialysis weight when pre-dialysis BUN was drawn. 
Clinical Module / Adequacy of DialysisRQMT_1533BlankIndicates the pre-dialysis weight unit of measure. 
Clinical Module / Adequacy of DialysisRQMT_1534Post-Dialysis WeightIndicates post-dialysis weight when post-dialysis BUN was drawn. 
Clinical Module / Adequacy of DialysisRQMT_1535BlankIndicates the post-dialysis weight unit of measure. 
Clinical Module / Adequacy of DialysisRQMT_1536Delivered Minutes of BUN Hemodialysis SessionIndicates the actual delivered time on hemodialysis in minutes at session when Blood Urea Nitrogen (BUN)s were drawn. 
Clinical Module / Adequacy of DialysisRQMT_1537Body Surface Area (BSA) CorrectedIndicates if the creatinine clearance is corrected for body surface area, using standard methods. 
Clinical Module / Anemia ManagementRQMT_308BlankIndicates the date of pre-dialysis serum ferritin concentration value. 
Clinical Module / Anemia ManagementRQMT_310BlankIndicates the date of pre-dialysis % transferrin (TSAT) (iron) saturation value. 
Clinical Module / Anemia ManagementRQMT_312BlankIndicates the date of pre-dialysis reticulocyte Hb content (CHr) value. 
Clinical Module / Anemia ManagementRQMT_1341Hemoglobin (Hgb) (g/dL)Indicates the hemoglobin value (g/dl) for the selected patient. 
Clinical Module / Anemia ManagementRQMT_1342BlankIndicates the date the hemoglobin value was taken for the selected patient. 
Clinical Module / Anemia ManagementRQMT_1501Ferritin (ng/mL)Indicates the pre-dialysis serum ferritin concentration value. 
Clinical Module / Anemia ManagementRQMT_1502Iron Saturation (TSAT) (%)Indicates the pre-dialysis % transferrin (TSAT) (iron) saturation value. 
Clinical Module / Anemia ManagementRQMT_1505Reticulocyte Hemoglobin (CHr) (pg)Indicates the pre-dialysis reticulocyte Hb content (CHr) value. 
Clinical Module / Clinical SearchRQMT_795Collection TypeIndicates the collection type based on patient's modality to identify patients for search. 
Clinical Module / ESARQMT_306BlankIndicates the date that the value of ESA Prescribed actually changed (prescription began or ended). 
Clinical Module / ESARQMT_1220Other ESA Agent PrescribedIndicates which ESA Agent was prescribed when selection is not in the ESA Agent dropdown list. 
Clinical Module / ESARQMT_1221Other ESA Monthly Dose MeasureIndicates an ESA prescribed dosage other than the selections given in the ESA Monthly Dose dropdown for a given month.

Note:
Home is defined as Prescribed
In-Center is defined as Administered
 
Clinical Module / ESARQMT_1438ESA Agent PrescribedErythropoiesis-Stimulating Agents (ESA) are man-made forms of the protein human erythropoietin. ESAs are given to patients with low red blood counts due to kidney failure, or due to side effects from other drugs, or given to patients scheduled for certain types of elective surgery. 
Clinical Module / ESARQMT_1439ESA Monthly DoseIndicates the ESA prescribed dosage for a given month.

Note:
Home is defined as Prescribed
In-Center is defined as Administered
 
Clinical Module / ESARQMT_1440ESA RouteThe route of administration prescribed for Erythropoiesis-Stimulating Agent (ESA) as either Intravenous Push (IVP) or Subcutaneous (SC). 
Clinical Module / ESARQMT_1498ESA AdministeredIndicates if patient has a current prescription for an erythropoiesis-stimulating agent (ESA), such as EPO or equivalent. 
Clinical Module / Fluid Weight ManagementRQMT_1052Post-Dialysis Target Weight for SessionIndicates if patient was prescribed a post-dialysis target weight for session 
Clinical Module / Fluid Weight ManagementRQMT_1499Post Dialysis Weight Assessment DateIndicates the date of a patient's last formal post dialysis weight assessment 
Clinical Module / General - ClinicalRQMT_114SuffixIndicates the patients last name suffix, if there is one. 
Clinical Module / General - ClinicalRQMT_775Last Name GroupAllows a user to select a patient according to his / her last names group. 
Clinical Module / General - ClinicalRQMT_776Collection TypeIndicates which collection type the user wishes to work with. 
Clinical Module / General - ClinicalRQMT_777Clinical MonthThe month the end user will be entering the clinical data for. 
Clinical Module / HospitalizationRQMT_1026All Hospital VisitsIndicates if a patient was hospitalized or went to the hospital emergency room 
Clinical Module / HospitalizationRQMT_1126Name of HospitalIndicates the name of the hospital where patient is being treated 
Clinical Module / HospitalizationRQMT_1301Hospitalization IDUnique identifier for hospitalization record 
Clinical Module / HospitalizationRQMT_1503Admission DateIndicates the date a dialysis patient was admitted to the hospital or taken to the emergency room. 
Clinical Module / HospitalizationRQMT_1504Discharge DateIndicates the date a dialysis patient was discharged from the hospital. 
Clinical Module / InfectionRQMT_1040Outpatient Antibiotics AdministeredIndicates if a prescription antibiotic therapy was initiated within the month 
Clinical Module / InfectionRQMT_1209Infection Hospitalization DateIndicates the date the patient was hospitalized due to the infection on antibiotics 
Clinical Module / InfectionRQMT_1302Infection IDUnique identifier for infection record 
Clinical Module / InfectionRQMT_1506Infection Requires HospitalizationIndicates if an infection requires the patient to be hospitalized 
Clinical Module / IronRQMT_981Intravenous (IV) IronIndicates Intravenous (IV) Iron prescription Agent 
Clinical Module / IronRQMT_982Intravenous (IV) Iron DoseIndicates the Intravenous (IV) Iron prescribed dosage or changed dosage total for a given month.

Note:
Home is defined as Prescribed
In-Center is defined as Administered
 
Clinical Module / IronRQMT_986Oral (PO) Iron DoseIndicates the Oral (PO) Iron prescribed dosage or changed dosage total for a given month

Note:
Home is defined as Prescribed
In-Center is defined as Administered
 
Clinical Module / IronRQMT_1226Other Intravenous (IV) IronIndicates the Intravenous (IV) Iron prescription Agent other than the medications in the Intravenous Iron selection list. 
Clinical Module / IronRQMT_1227Other Intravenous (IV) Iron Dose MeasureIndicates the 'Other' Intravenous (IV) Iron prescribed dosage or changed dosage (not mg or g as in the IV Iron Dose selection list) 
Clinical Module / IronRQMT_1228Other Oral (PO) IronIndicates what 'Other' type of Oral (PO) Iron is prescribed, not included in the Oral Iron selection list. 
Clinical Module / IronRQMT_1229Other Oral (PO) Iron Dose MeasureIndicates the 'Other' Oral Iron prescribed dosage or changed dosage (not in the Oral Iron Dose selection list) 
Clinical Module / IronRQMT_1507BlankIndicates the date that Intravenous (IV) Iron was administered. 
Clinical Module / IronRQMT_1508Intravenous (IV) Iron AdministeredIndicates if patient had IV iron administered. 
Clinical Module / IronRQMT_1509BlankIndicates the date that Oral (PO) Iron was prescribed. 
Clinical Module / IronRQMT_1510Oral (PO) Iron PrescribedIndicates if Oral (PO) Iron was prescribed 
Clinical Module / Mineral MetabolismRQMT_318BlankIndicates the date of the corrected serum calcium value. 
Clinical Module / Mineral MetabolismRQMT_1335Serum Albumin (g/dL)Indicates the serum albumin value (g/dl) for the patient. 
Clinical Module / Mineral MetabolismRQMT_1336BlankIndicates the date the serum albumin value was collected for the patient. 
Clinical Module / Mineral MetabolismRQMT_1337Serum Albumin Lower Limit (g/dL)Indicates the serum albumin lower limit of the normal range for the laboratory which performed the serum albumin test. 
Clinical Module / Mineral MetabolismRQMT_1338Serum Albumin Lab MethodIndicates the serum albumin lab method used (BCG or BCP). 
Clinical Module / Mineral MetabolismRQMT_1466Corrected Calcium (mg/dL)Indicates the pre-dialysis serum calcium value, corrected for sub-lower limit results of Serum Albumin from same set of blood work. 
Clinical Module / Mineral MetabolismRQMT_1467Uncorrected Serum Calcium (mg/dL)Indicates the raw pre-dialysis serum calcium value, not corrected for sub-Lower Limit results of Serum Albumin from same set of blood work. 
Clinical Module / Mineral MetabolismRQMT_1538BlankIndicates the date of the uncorrected serum calcium value. 
Clinical Module / VaccinationRQMT_1461Influenza Vaccination DateIndicates the date of the patient's Influenza Vaccination 
Clinical Module / VaccinationRQMT_1520Hepatitis B surface antibody (anti-HBs)Indicates patient's Hepatitis B surface antibody (anti-HBs) Lab Level 
Clinical Module / VaccinationRQMT_1521Hepatitis B surface antibody (anti-HBs) PerformedIndicates the date of the Hepatitis B surface antibody (anti-HBs) Lab test was performed 
Clinical Module / VaccinationRQMT_1522Hepatitis B Vaccination Not ReceivedIndicates whether a patient received a Hepatitis B Vaccination. 
Clinical Module / VaccinationRQMT_1523Hepatitis B Vaccination DatesIndicates the dates of the Hepatitis B Vaccination 
Clinical Module / VaccinationRQMT_1524Hepatitis B Booster Date(s)Indicates the dates Hepatitis B Boosters were administered 
Clinical Module / VaccinationRQMT_1525Influenza Vaccination Not ReceivedIndicates whether a patient received an Influenza Vaccination. 
Clinical Module / VaccinationRQMT_1526Site Received Influenza VaccinationIndicates if Influenza Vaccination was received in or out of a facility 
Clinical Module / VaccinationRQMT_1527Pneumococcal Vaccination Not ReceivedIndicates whether a patient received a Pneumococcal Vaccination. 
Clinical Module / VaccinationRQMT_1528Pneumococcal Vaccination YearIndicates the year of the patient's Pneumococcal (Pneumonia) vaccination 
Clinical Module / VaccinationRQMT_1529{See field level requirements}Indicates the year of the patient's Pneumococcal (Pneumonia) vaccination 
Clinical Module / VaccinationRQMT_1530Exclusion ReasonIndicates the reason why a specific vaccination was not administered. 
Clinical Module / Vascular AccessRQMT_399Date of Reported Dialysis SessionIndicates the date of the dialysis session being referenced by the user when supplying the patient's vascular access details. 
Clinical Module / Vascular AccessRQMT_401AV Fistula Usable DateIndicates the date AVF is usable. 
Clinical Module / Vascular AccessRQMT_402AV Fistula StateIndicates the present state, as captured in this reporting period, of the patient's AV Fistula, if present. 
Clinical Module / Vascular AccessRQMT_403AV Graft StateIndicates the present state, as captured in this reporting period, of the patient's AV Graft, if present. 
Clinical Module / Vascular AccessRQMT_1138Date Access Type ChangedIndicates the date that the Access Type for Dialysis was actually changed to this access type. 
Clinical Module / Vascular AccessRQMT_1139AV Fistula Creation DateIndicates the date of AVF creation. 
Clinical Module / Vascular AccessRQMT_1300Current Access TypeIndicates the type of access that was used for dialysis on the dialysis session date reported. 
Clinical Module / Vitamin D AnalogRQMT_988Serum Parathyroid Hormone (PTH) ValueIndicates the pre-dialysis serum Parathyroid Hormone Value (PTH) 
Clinical Module / Vitamin D AnalogRQMT_989Serum Parathyroid Hormone (PTH) Collection DateIndicates the date the Serum Parathyroid Hormone (PTH) value was collected. 
Clinical Module / Vitamin D AnalogRQMT_1012Serum Parathyroid Hormone TypeIndicates the type of Serum Parathyroid Hormone 
Clinical Module / Vitamin D AnalogRQMT_1013Non-Oral Vitamin D Analog PrescribedIndicates if Non-Oral Vitamin D Analog has been prescribed 
Clinical Module / Vitamin D AnalogRQMT_1014Non-Oral Vitamin D AnalogIndicates the Non-Oral Vitamin D Analog 
Clinical Module / Vitamin D AnalogRQMT_1015Non-Oral Vitamin D Analog Dosage (mcg)Indicates the Non-Oral Vitamin D Analog Dose 
Clinical Module / Vitamin D AnalogRQMT_1016Non-Oral Vitamin D Analog RouteIndicates the prescribed Non-Oral Vitamin D Analog Route 
Clinical Module / Vitamin D AnalogRQMT_1017Oral Vitamin D Analog PrescribedIndicates if Oral Vitamin D Analog has been prescribed 
Clinical Module / Vitamin D AnalogRQMT_1018Oral Vitamin D AnalogIndicates the prescribed Oral Vitamin D Analog 
Clinical Module / Vitamin D AnalogRQMT_1019Oral Vitamin D Analog DosageIndicates the prescribed Oral Vitamin D Analog Dose 
Clinical Module / Vitamin D AnalogRQMT_1230Other Non-Oral Vitamin D AnalogIndicates the 'Other' Non-Oral Vitamin D Analog (not included in the Non-Oral Vitamin D Analog selection list) 
Clinical Module / Vitamin D AnalogRQMT_1231Other Oral Vitamin D AnalogIndicates the 'Other' prescribed Oral Vitamin D Analog, not in the Oral Vitamin D Analog selection list. 
Clinical Module / Vitamin D AnalogRQMT_1235Other Serum Parathyroid Hormone TypeIndicates the 'Other' type of Serum Parathyroid Hormone (an option not included in the Pre-Dialysis Serum PTH Type selection list) 
FacilityRQMT_1406CityIndicates the physical city in which the facility is located. 
FacilityRQMT_1409StateIndicates the state in which the facility's physical address is located. 
FacilityRQMT_1554CCN Start DateIndicates the CCN Start Date of when CCN Change was effective. 
FacilityRQMT_1555CCN End DateIndicates the CCN End Date of when a newly created CCN Change has occurred. 
Facility / 2744RQMT_1067Patient Vocational Rehabilitation Status DateIndicates the date of the patient' Vocational Rehab status. 
Facility / 2744RQMT_1068Patient Employment Status DateIndicates the date of the patient' employment status. 
Facility / 2744RQMT_1069Patient School Status DateIndicates the date of the patient's school status for the 2744 survey period. 
Facility / 2744RQMT_1070Expected Self Care SettingThe type of setting in which a patient will be performing dialysis. 
Facility / 2744RQMT_1071Medicare Enrollment StatusIdentifies the status of a patient's Medicare eligibility. 
Facility / 2744RQMT_1072Medicare Enrollment Status DateThe date of a patient Medicare enrollment status. 
Facility / 2744RQMT_1073Dialysis Time PeriodPatient dialysis time period is determined by Day or Nocturnal. 
Facility / 2744RQMT_1074Patient Citizenship StatusThis attribute indicates the patient' citizenship status of the United States. 
Facility / 2744RQMT_1075Patient Citizenship Status DateIndicates the date of the patient' citizenship status. 
Facility / 2744RQMT_1076Hemodialysis Incenter Dialysis Treatments CountCount of Patients within the Survey Period that have Hemodialysis Incenter Dialysis Treatment. Field 36 on the OMB CMS-2744A. 
Facility / 2744RQMT_1077Other Incenter Dialysis Treatments CountCount of Patients within the Survey Period that have Other Incenter Dialysis Treatment. Field 37 on the OMB CMS-2744A. 
Facility / 2744RQMT_1078Count of Full Time RN Staff PositionsCount of Full Time RN Staff Positions entered on Field 38a on the OMB CMS-2744A. 
Facility / 2744RQMT_1079Count of Full Time LPN / LVN Staff PositionsCount of Full Time LPN / LVN Staff Positions entered on Field 38b on the OMB CMS-2744A. 
Facility / 2744RQMT_1080Count of Full Time PCT Staff PositionsCount of Full Time PCT Staff Positions entered on Field 38c on the OMB CMS-2744A. 
Facility / 2744RQMT_1081Count of Full Time APN Staff PositionsCount of Full Time APN Staff Positions entered on Field 38d on the OMB CMS-2744A. 
Facility / 2744RQMT_1082Count of Full Time Dietitian Staff PositionsCount of Full Time Dietitian Staff Positions entered on Field 38e on the OMB CMS-2744A. 
Facility / 2744RQMT_1083Count of Full Time Social Worker Staff PositionsCount of Full Time Social Worker Staff Positions entered on Field 38f on the OMB CMS-2744A. 
Facility / 2744RQMT_1084Count of Part Time RN Staff PositionsCount of Part Time RN Staff Positions entered on Field 39a on the OMB CMS-2744A. 
Facility / 2744RQMT_1085Count of Part Time LPN / LVN Staff PositionsCount of Part Time LPN / LVN Staff Positions entered on Field 39b on the OMB CMS-2744A. 
Facility / 2744RQMT_1086Count of Part Time PCT Staff PositionsCount of Part Time PCT Staff Positions entered on Field 39c on the OMB CMS-2744A. 
Facility / 2744RQMT_1087Count of Part Time APN Staff PositionsCount of Part Time APN Staff Positions entered on Field 39d on the OMB CMS-2744A. 
Facility / 2744RQMT_1088Count of Part Time Dietitian Staff PositionsCount of Part Time Dietitian Staff Positions entered on field 39e on the OMB CMS-2744A. 
Facility / 2744RQMT_1089Count of Part Time Social Workers Staff PositionsCount of Part Time Social Workers Staff Positions entered on Field 39f on the OMB CMS-2744A. 
Facility / 2744RQMT_1090Coiunt of Full Time RN Open PositionsCount of Full Time RN Open Positions entered on Field 40a on the OMB CMS-2744A. 
Facility / 2744RQMT_1091Count of Full Time PCT Open PositionsCount of Full Time PCT Open Positions entered on Field 40c on the OMB CMS-2744A. 
Facility / 2744RQMT_1092Count of Full Time APN Open PositionsCount of Full Time APN Open Positions entered on Field 40d on the OMB CMS-2744A. 
Facility / 2744RQMT_1093Count of Full Time Dietitian Open PositionsCount of Full Time Dietitian Open Positions entered on Field 40e on the OMB CMS-2744A. 
Facility / 2744RQMT_1094Count of Full Time Social Worker Open PositionsCount of Full Time Social Worker Open Positions entered on Field 40f on the OMB CMS-2744A. 
Facility / 2744RQMT_1095Count of Part Time RN Open PositionsCount of Part Time RN Open Positions entered on Field 41a on the OMB CMS-2744A. 
Facility / 2744RQMT_1096Count of Part Time LPN / LVN Open PositionsCount of Part Time LPN / LVN Open Positions entered on Field 41b on the OMB CMS-2744A. 
Facility / 2744RQMT_1097Count of Part Time PCT Open PositionsCount of Part Time PCT Open Positions entered on Field 41c on the OMB CMS-2744A. 
Facility / 2744RQMT_1098Count of Part Time APN Open PositionsCount of Part Time APN Open Positions entered on Field 41d on the OMB CMS-2744A. 
Facility / 2744RQMT_1099Count of Part Time Dietitian Open PositionsCount of Part Time Dietitian Open Positions entered on Field 41e on the OMB CMS-2744A. 
Facility / 2744RQMT_1100Count of Part Time Social Worker Open PositionsCount of Part Time Social Worker Open Positions entered on Field 41f on the OMB CMS-2744A. 
Facility / 2744RQMT_1101Count of Full Time LPN / LVN Open PositionsCount of Full Time LPN / VN Open Positions entered on Field 40b on the OMB CMS-2744A. 
Facility / 2744RQMT_1102Dialysis Patients Awaiting TransplantsCount of Dialysis patients awaiting transplants entered on Field 51 on the OMB CMS-2744A. 
Facility / 2744RQMT_1103Non Dialysis Patients Awaiting TransplantsCount of Non Dialysis patients awaiting transplants entered on Field 52 on the OMB CMS-2744A. 
Facility / 2744RQMT_1104Electronic 2744 VersionThe electronic 2744 will be generated as a 'Draft' or as a 'Final' version. 
Facility / 2744RQMT_1105Electronic 2744 StatusIndicates if the form has been accepted or rejected. 
Facility / 2744RQMT_1106Survey Period Begin DateThe date that is the starting date range for system generated entries and manual entries for the electronic 2744. 
Facility / 2744RQMT_1107Survey Period End DateThe date that is the ending date range for system generated entries and manual entries for the electronic 2744. 
Facility / 2744RQMT_11082744 Survey Period CommentsElectronically generated errors and warning messages as well as manually entered comments are placed into the electronic version of the 2744. 
Facility / 2744RQMT_1140Incenter Patients Receiving Care Beginning of Survey PeriodThis field must contain a count of patients dialyzing in the facility at the beginning of the survey period. 
Facility / 2744RQMT_1141Home Patients Receiving Care Beginning of Survey PeriodThis field must contain a count of patients dialyzing in the facility at the beginning of the survey period. 
Facility / 2744RQMT_1142Home Patients Receiving Care Beginning of Survey PeriodTotal of fields 01 add 02 on the CMS-2744 Survey Period. 
Facility / 2744RQMT_1143Incenter started first time everThis field must contain a count that will equal the number of patients on the facilitys register at the beginning of the survey period. 
Facility / 2744RQMT_1144Home started first time everThis field must contain a count of newly diagnosed ESRD home patients who, after being stabilized on dialysis, have successfully completed a course of self-dialysis training and began home (their initial course of home dialysis after training) dialysis during the survey period. 
Facility / 2744RQMT_1145Incenter restartedThis field must contain a count of incenter patients who restarted incenter dialysis during the survey period. 
Facility / 2744RQMT_1146Home restartedThis field must contain a count of incenter patients who restarted home dialysis during the survey period. 
Facility / 2744RQMT_1147Incenter TransferredThis field must contain a count of incenter patients admitted to the facility who were formally transferred from another dialysis facility during the survey period and who are continuing a regular course of dialysis at the selected facility. 
Facility / 2744RQMT_1148Home TransferredThis field must include a count of home patients who were formally transferred by another facility during the survey period to the selected facility for ongoing medical supervision and responsibility. 
Facility / 2744RQMT_1149Incenter Transplant ReturnThis field must include a count of incenter patients who returned to incenter dialysis during the survey period after a transplant failed. 
Facility / 2744RQMT_1150Home Transplant ReturnThis field must include a count of home patients who returned to home dialysis during the survey period after a transplant failed. 
Facility / 2744RQMT_1151Incenter DeathsThis field must include a count of incenter dialysis patients who died during the survey period. 
Facility / 2744RQMT_1152Home DeathsThis field must include a count of home dialysis patients who died during the survey period. 
Facility / 2744RQMT_1153Incenter Recovered FunctionThis field must include a count of incenter patients who recovered function of their native kidneys and ceased chronic incenter dialysis during the survey period. 
Facility / 2744RQMT_1154Home Recovered FunctionThis field must include a count of home patients who recovered function of their native kidneys and ceased chronic home dialysis during the survey period. 
Facility / 2744RQMT_1155Incenter Received TransplantThis field must include a count of incenter patients who received a kidney transplant during the survey period. 
Facility / 2744RQMT_1156Home Received TransplantThis field must include a count of home patients who received a kidney transplant during the survey period. 
Facility / 2744RQMT_1157Incenter TransferThis field must include a count of incenter dialysis patients who permanently transferred to another dialysis facility for their ongoing dialysis during the survey period; that is, those patients whose ongoing, routine medical supervision became the responsibility of another dialysis facility. 
Facility / 2744RQMT_1158Home TransferThis field must include a count of home patients who had been followed by the selected facility but who are now permanently followed by another home dialysis program. 
Facility / 2744RQMT_1159Incenter DiscontinueThis field must contain a count of chronic patients who permanently discontinued dialysis (excluding those reported in fields 08A, 09A, 10A, 11A and 13A) who had been dialyzing incenter during the survey period. 
Facility / 2744RQMT_1160Home DiscontinueThis field must contain a count of chronic home patients who permanently discontinued dialysis (excluding those reported in fields 08B, 09B, 10B, 11B) who had been dialyzing at home during the survey period. 
Facility / 2744RQMT_1161Incenter Other (LTFU)This field must include a count of patients, who had been dialyzing incenter, who left the dialysis program during the survey period, and whose current status is unknown to the facility (lost to follow-up). 
Facility / 2744RQMT_1162Home Other (LTFU)This field must include a count of patients, followed by the facility, who had been dialyzing at home, who was removed from the facilitys rolls during the survey period, and whose current status is unknown (lost to follow-up). 
Facility / 2744RQMT_1163Incenter HemodialysisThis field must contain a count of the number of patients who, at the end of the survey period, were receiving staff-assisted hemodialysis or performing incenter self-hemodialysis. 
Facility / 2744RQMT_1164Incenter Other (Dialysis)This field must contain a count of patients who, at the end of the survey period, were receiving dialysis, other than hemodialysis. 
Facility / 2744RQMT_1165Hemodialysis Self TrainingThis field must contain a count of patients who are in a self hemodialysis training program as of the end of the survey period. Patients are to be reported in this field only if the training is designed to enable them to perform their own self-dialysis incenter or at home. 
Facility / 2744RQMT_1167CAPD Self TrainingThis field must contain a count of patients who are in a CAPD training program as of the end of the survey period. Patients are to be reported in this field only if the training is designed to enable them to independently perform CAPD. 
Facility / 2744RQMT_1168CCPD Self TrainingThis field must contain a count of patients who are in a CCPD training program as of the end of the survey period. Patients are to be reported in this field only if the training is designed to enable them to independently perform CCPD. 
Facility / 2744RQMT_1169Other Self TrainingThis field must contain a count of patients who are in a self dialysis training program, e.g., a self intermittent peritoneal dialysis (IPD) training program as of the end of the survey period. Patients are to be reported in this field only if the training is designed to enable them to perform their own self-dialysis incenter or at home. 
Facility / 2744RQMT_1170Total Incenter DialysisThis field must contain a count of patients who are incenter status as of the end of the survey period (the sum of fields 14 through 19). 
Facility / 2744RQMT_1171Home HemodialysisThis field must contain a count of patients who were hemodialyzing at home as of the end of the survey period. 
Facility / 2744RQMT_1172Home CAPDThis field must contain a count of patients who are on CAPD at home as of the end of the survey period. 
Facility / 2744RQMT_1173Home CCPDThis field must contain a count of the number of patients who are on CCPD at home as of the end of the survey period. 
Facility / 2744RQMT_1174Home Other (Dialysis)This field must contain a count of patients who are on another type of home dialysis as of the end of the survey period. (Intermittent peritoneal dialysis (IPD)) 
Facility / 2744RQMT_1175Total Home DialysisThis field must contain a count of patients who are in home status as of the end of the survey period (the sum of Fields 21 through 24). 
Facility / 2744RQMT_1176Total PatientsThe total number of patients registered at the facility at the end of the survey period. This field must equal the sum of Field 20 and Field 25. 
Facility / 2744RQMT_1177Medicare EnrolledThis field must contain a count of patients at the end of the survey period that was enrolled in Medicare. 
Facility / 2744RQMT_1178Medicare Application PendingThis field must contain a count of patients at the end of the survey period that had Medicare application pending. 
Facility / 2744RQMT_1179Non Medicare EligibleThis field must contain a count of patients at the end of the survey period who were not enrolled in Medicare and did not have Medicare applications pending. 
Facility / 2744RQMT_1180Incenter Hemodialysis DayThis field must contain a count of hemodialysis patients who are dialyzing incenter and during the day, for more than 4 times per week. 
Facility / 2744RQMT_1182Home Hemodialysis DayThis field must contain a count of hemodialysis patients who are dialyzing at home and during the day, for more than 4 times per week. 
Facility / 2744RQMT_1183Incenter Hemodialysis NocturnalThis field must contain a count of hemodialysis patients who are dialyzing incenter, and nocturnal for more than 4 times per week. 
Facility / 2744RQMT_1184Home Hemodialysis NocturnalThis field must contain a count of hemodialysis patients who are dialyzing at home and nocturnal for more than 4 times per week. 
Facility / 2744RQMT_1185Patient Age Eighteen thru FiftyfourThis field must contain a count of dialysis patients who, as of end of survey period, were ages 18 through 54 dialyzing at the selected facility. 
Facility / 2744RQMT_1186Vocational Rehabilitation ServicesThis field must contain a count of Dialysis patients age 18 - 54 who are receiving or have received Vocational Rehabilitation Services (public or private) at the end of the survey period. 
Facility / 2744RQMT_1187Patients EmployedThis field must contain a count of patients, ages 18 through 54, who are employed either full-time or part-time receiving taxable wages from an employer or who was self-employed and paid taxes on earnings. 
Facility / 2744RQMT_1188Patients Attending SchoolThis field must contain a count of patients, ages 18 through 54 who are attending school either full-time or part time, who were enrolled in any formal education or training program. 
Facility / 2744RQMT_1189Patient TransplantsThis field must contain a count of the number of patients who received a kidney transplant at the selected facility during the survey period. Patients are to be counted only once regardless of how many transplants took place. 
Facility / 2744RQMT_1190Transplant Patients Medicare EnrolledThis field must contain a count of patients transplanted during the survey period who were enrolled in Medicare. Count Medicare transplant recipients based on enrollment rather than primary insurer. 
Facility / 2744RQMT_1191Transplant Patients Medicare PendingThis field must contain a count of patients transplanted during the survey period that had Medicare applications pending. 
Facility / 2744RQMT_1192Transplant Patients Non-Medicare US ResThis field must contain a count of patients transplanted during the survey period who were not enrolled in Medicare and did not have Medicare applications pending. US citizen or a foreign national US resident. 
Facility / 2744RQMT_1193Transplant Patients Non-Medicare Non US ResThis field must contain a count of patients transplanted during the survey period who were not enrolled in Medicare, did not have Medicare applications pending and were neither a US Citizen or a US Resident. 
Facility / 2744RQMT_1194Transplant Patients Living Related DonorThis field must contain a count of living related donor kidney transplants performed at the selected facility during the survey period. 
Facility / 2744RQMT_1195Transplant Patients Living Unrelated DonorThis field must contain a count of living unrelated donor kidney transplants performed at the selected facility during the survey period. 
Facility / 2744RQMT_1196Transplant Patients Deceased DonorThis field must contain a count of deceased donor kidney transplants performed at the selected facility during survey period. 
Facility / 2744RQMT_1197Total Facility TransplantsThis field must contain a sum of fields 47 through 49. 
Facility / 2744RQMT_1199USERIDThe User Identification associated with the batch or online user that has entered comments on the CMS-2744. 
Facility / 2744RQMT_1200DateTime StampThe Date Time Stamp associated with the online or batch user that has entered comments on the CMS-2744. 
Facility / AttestationRQMT_1268Attestation Performance YearThe year that is being measured by the ESRD QIP. The value will be the same for every record in the file, equal to the prior calendar year. 
Facility / AttestationRQMT_1269Mineral Metabolism Monitoring Attestation Indicator"N/A" (Not Applicable) indicates that the facility is not eligible for the Mineral Metabolism reporting measure because it treated 1 or 0 eligible patients over the course of the entire performance period. 
Facility / AttestationRQMT_1270ICH CAHPS Survey Attestation Indicator"NA" (Not Applicable) indicates that the facility is not eligible for the ICH CAHPS reporting measure because it treated less than 30 eligible patients over the course of the entire performance period. 
Facility / AttestationRQMT_1548Anemia Management Monitoring Attestation Indicator"NA" (Not Applicable) indicates that the facility is not eligible for the Anemia Management reporting measure because it treated 1 or 0 eligible patients eligible patients over the course of the entire performance period. 
Facility / General - FacilityRQMT_1CROWN FAC IDSystem-generated unique characters used in CROWNWeb to identify facilities. 
Facility / General - FacilityRQMT_2Facility Legal NameIndicates the facility's legal name. 
Facility / General - FacilityRQMT_3Physical AddressIndicates the physical street address of the facility. 
Facility / General - FacilityRQMT_4BlankIndicates the physical street address 2 of the facility. 
Facility / General - FacilityRQMT_5CityIndicates the physical city in which the facility is located. 
Facility / General - FacilityRQMT_6StateIndicates the state in which the facilitys physical address is located. 
Facility / General - FacilityRQMT_7Zip CodeIndicates the zip code of the facility's physical address. 
Facility / General - FacilityRQMT_8BlankIndicates the +4 code that follows the zip code for the facility's physical address. 
Facility / General - FacilityRQMT_9CountyIndicates the county in which the facility's physical address is located. 
Facility / General - FacilityRQMT_10NetworkIndicates the ESRD Network where the facility resides. 
Facility / General - FacilityRQMT_12Facility NPIIndicates the facility's National Provider Identifier (NPI). 
Facility / General - FacilityRQMT_25Managed ByIndicates who manages the facility; may not be the same as ownership. 
Facility / General - FacilityRQMT_27Owned ByIndicates who owns the facility. 
Facility / General - FacilityRQMT_29Program TypeIndicates whether facility is a transplant or dialysis facility. 
Facility / General - FacilityRQMT_30StatusIndicates whether facility is open or closed. 
Facility / General - FacilityRQMT_38Mailing Address Same as Physical AddressIndicates that the mailing address is the same as the physical address. 
Facility / General - FacilityRQMT_39Mailing AddressIndicates the facility's mailing street address. 
Facility / General - FacilityRQMT_40BlankIndicates the facility's mailing street address. 
Facility / General - FacilityRQMT_41CityIndicates the city in which the facility's mailing address is located. 
Facility / General - FacilityRQMT_42StateIndicates the state in which the facility's mailing address is located. 
Facility / General - FacilityRQMT_43Zip CodeIndicates the zip code for the facility's mailing address. 
Facility / General - FacilityRQMT_44BlankIndicates the +4 code that follows the zip code for the facility's mailing address. 
Facility / General - FacilityRQMT_45PhoneIndicates the facility's main phone number. 
Facility / General - FacilityRQMT_48FaxIndicates facility's main fax number. 
Facility / General - FacilityRQMT_59Medicare Certified Services OfferedIndicates all of the Medicare-certified services the facility offers. 
Facility / General - FacilityRQMT_60Additional Services Offered (Non-Medicare)Indicates all additional or non-certified services the facility offers. 
Facility / General - FacilityRQMT_66Provider Use TypeIndicates the type of program for which the facility has been certified. 
Facility / General - FacilityRQMT_359Facility NPIIndicates the facility's NPI where the patient is receiving care. 
Facility / General - FacilityRQMT_778Facility DBA Name Same as Legal NameFacility DBA Name Same as Legal Name checkbox 
Facility / General - FacilityRQMT_1133Other OwnerIndicates another dialysis organization that has part ownership of the facility. 
Facility / General - FacilityRQMT_1134If Other, Please Enter NameIndicates another dialysis organization that has part ownership of the facility, and the value is not contained within the standard affiliations. 
Facility / General - FacilityRQMT_1135Authorized Batch Submitting OrganizationIndicates the Batch Submitting Organization who is specified on the facility's Delegation of Authority form (CMS-10268). 
Facility / General - FacilityRQMT_1137Hospital CCNA secondary CCN that may be assigned to a hospital that defines its ESRD services as a hospital. 
Facility / General - FacilityRQMT_1353Facility DBA NameIndicates the facility's 'doing business as' name. 
Facility / General - FacilityRQMT_1354Facility CCNIndicates the facility's Medicare certified number assigned by CMS. 
Facility / General - FacilityRQMT_1401Physical AddressIndicates the physical street address of the facility. 
Facility / General - FacilityRQMT_1403BlankIndicates the physical street address 2 of the facility. 
Facility / NotificationsRQMT_1238NoneUnique ID for Notifications and Accretions 
Facility / NotificationsRQMT_1239Date of BirthDOB Data submitted from REMIS that is conflicting with DOB in CROWNWeb. 
Facility / NotificationsRQMT_1240Date of DeathDOD data submitted from REMIS that is conflicting with DOD in CROWNWeb. 
Facility / NotificationsRQMT_1241First NameFirst name Data submitted from REMIS that is conflicting with first name in CROWNWeb. 
Facility / NotificationsRQMT_1242Medicare Claim NumberHICNUM data submitted from REMIS that is conflicting with HICNUM in CROWNWeb. 
Facility / NotificationsRQMT_1243TransplantTransplant date data submitted from REMIS that is conflicting with transplant date in CROWNWeb. 
Facility / NotificationsRQMT_1244Transplant Failuretransplant fail date data submitted from REMIS that is conflicting with transplant fail date in CROWNWeb. 
Facility / NotificationsRQMT_1245Ext. Source Effective DateEffective date submitted from REMIS. 
Facility / NotificationsRQMT_1246GenderGender data submitted from REMIS that is conflicting with gender in CROWNWeb. 
Facility / NotificationsRQMT_1247Social Security NumberSSN data submitted from REMIS that is conflicting with SSN in CROWNWeb. 
Facility / NotificationsRQMT_1248Last NameLast name data submitted from REMIS that is conflicting with last name in CROWNWeb. 
Facility / NotificationsRQMT_1249External SourceWhere REMIS received the data that is being passed on. 
Facility / NotificationsRQMT_1250FacilityPrimary Provider provided by REMIS. 
Facility / NotificationsRQMT_1252TreatmentModality received from REMIS 
Facility / NotificationsRQMT_1253ActionThe action that is being taken by the end user for the specific notification or accretion. 
Facility / NotificationsRQMT_1254TransferAllows for a notification or an accretion to be transferred to a network and / or facility. 
Facility / NotificationsRQMT_1256Days OpenThe amount of time the Notification or Accretion record has been open (aging number) 
Facility / NotificationsRQMT_1257commentsAllows for the entering of comments for notifications and accretions. 
Facility / NotificationsRQMT_1258NoneNetwork number listed in the REMIS data (notification or accretion) 
Facility / NotificationsRQMT_1259NoneCROWNWeb patient ID that has been captured in the REMIS notification. 
Facility / NotificationsRQMT_1261NoneREMIS Patient ID, make available to reference REMIS data when needed. 
Facility / NotificationsRQMT_1262Ext. Source Physcial Address StateThe state REMIS has listed for the patient. 
Facility / NotificationsRQMT_1263Physical Address ZipZip Code REMIS has listed for the patient. 
Facility / NotificationsRQMT_1264Treatment Start DateREMIS modality start date, passed from REMIS. 
Facility / NotificationsRQMT_1265Action TypeIdentifies the type of discrepancy generated from REMIS, either a notification or accretion. 
Facility / Personnel-Practitioner GeneralRQMT_84BlankSystem-generated unique number used in CROWNWeb to identify personnel. 
Facility / Personnel-Practitioner GeneralRQMT_91Job TitleRepresents the job title of personnel as assigned by a facility. Job titles are not necessarily standardized across facilities. 
Facility / Personnel-Practitioner GeneralRQMT_92Job CodeStandardized job code assigned to a person for their position at their assigned facility. The job codes may not match the facility's job titles, but the end user assigns the closed job code definition. 
Facility / Personnel-Practitioner GeneralRQMT_93UPINUnique physician identifier number associated with various medical personnel including MD, Physician's Assistants, Clinical Nurse Specialists, and Nurse Practitioners. This value is assigned to personnel outside the CROWNWeb system. 
Facility / Personnel-Practitioner GeneralRQMT_94Personnel NPIIndicates the personnel's National Provider Identifier (NPI), which is a standard unique health identifier. 
Facility / Personnel-Practitioner GeneralRQMT_98CityIndicates the personnel's preferred mailing city. 
Facility / Personnel-Practitioner GeneralRQMT_99StateIndicates the personnel's preferred mailing state. 
Facility / Personnel-Practitioner GeneralRQMT_100Zip CodeIndicates the personnel's preferred mailing zip code. 
Facility / Personnel-Practitioner GeneralRQMT_102E-MailIndicates the personnel's preferred e-mail address. 
Facility / Personnel-Practitioner GeneralRQMT_110Organization Unique Personnel IdentifierIndicates the organization's unique identifier for the person. 
Facility / Personnel-Practitioner GeneralRQMT_781Job DescriptionJob description selection from the Job Code list. 
Facility / Personnel-Practitioner GeneralRQMT_782CountyThe county in which the personnel's mailing address is located. 
Facility / Personnel-Practitioner GeneralRQMT_1390Business PhoneIndicates the personnel's business phone number. 
Facility / Personnel-Practitioner GeneralRQMT_1391Personnel Middle InitialThe person's legal middle initial. 
Facility / Personnel-Practitioner GeneralRQMT_1392Last Name SuffixIndicates the personnel's last name suffix, if there is one. 
GlobalRQMT_1293BlankIndicates the Primary Cause of Renal Failure code description for the primary cause of end stage renal disease for this patient. 
GlobalRQMT_1294Primary Cause of Renal Failure Indicates the ICD-10-CM code for the primary cause of end stage renal disease for this patient. 
Global / General - GlobalRQMT_356Transient StatusIndicates whether the patient is expected to be managed by the facility for less than 30 days or not. 
Global / General - GlobalRQMT_811LogoutAllows a user to logout of the system. 
Global / General - GlobalRQMT_812MM:SSA 15-minute count-down clock, which indicates the time a user has left in the system prior to automatically being logged out. 
Global / User Interfaces / PARTRQMT_153VerificationIndicates the date that the patient record was verified either through the PART Single User Interface or via Batch submission. 
Global / User Interfaces / PARTRQMT_783FilterIndicates the search criteria to filter and display patients when performing the PART Verification. 
Global / User Interfaces / PARTRQMT_784Use Date RangeIndicates the date range a user can enter or select to note the 'Begin' and 'End' date. 
Global / User Interfaces / PARTRQMT_785BlankIndicates the date range a user can enter or select to note the 'Begin' and 'End' date. 
Global / User Interfaces / PARTRQMT_786All / NoneAllows users to check / uncheck all / none of the patients displayed on-screen, while performing the PART Verification. 
Global / User Interfaces / PARTRQMT_787BlankIndicates a checkbox that allows a user to check / select a particular patient from the PART Verification list. 
Global / User Interfaces / PARTRQMT_788VerificationIndicates the user who verifies the patient record through the PART Single User Interface. 
Global / User Roles and Scope / General - User Role and ScoRQMT_818User Last NameAllows the end user to look up user last name to assign role(s) or scope(s). 
Global / User Roles and Scope / General - User Role and ScoRQMT_819User IDAllows the end user to enter User ID to conduct a search for User Name return. 
Global / User Roles and Scope / General - User Role and ScoRQMT_820User NameDisplays the unassigned and assigned user as determined by the end user role and scope. 
Global / User Roles and Scope / General - User Role and ScoRQMT_825Networks AvailableDisplays Network(s) available to assign to the user (as determined by their User Role and Scope). 
Global / User Roles and Scope / General - User Role and ScoRQMT_826Networks AssignedDisplays Network(s) to an end user (as determined by their User Role and Scope). 
Global / User Roles and Scope / User Role ManagerRQMT_821Roles AvailableDisplays all roles that can be assigned by the end user. 
Global / User Roles and Scope / User Role ManagerRQMT_822Roles AssignedDisplays roles assigned to the selected user. 
Global / User Roles and Scope / User Scope ManagerRQMT_823Facilities AvailableDisplays facility(s) available to assign to the user. 
Global / User Roles and Scope / User Scope ManagerRQMT_824Facilities AssignedDisplays facility(s)to an end user (as determined by their User Role and Scope). 
Patient Information / 2728 - Medical Evidence FormRQMT_284BlankThe attending physicians unique personnel identifier used in CROWNWeb. 
Patient Information / 2728 - Medical Evidence FormRQMT_288UPIN of Physician in Item 46Unique physician identifier number associated with various medical personnel including MD, Physician's Assistants, Clinical Nurse Specialists, and Nurse Practitioners. This value is assigned to personnel outside the CROWNWeb system, OR Indicates the personnel's National Provider Identifier (NPI), which is a standard unique health identifier. 
Patient Information / 2728 - Medical Evidence FormRQMT_292BlankSystem-generated form version 
Patient Information / 2728 - Medical Evidence FormRQMT_815BlankIndicates the Primary Cause of Renal Failure code description for the primary cause of end stage renal disease for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1303DateIndicates the date that the Physician rec-ertified and signed the form. 
Patient Information / 2728 - Medical Evidence FormRQMT_1304Check OneIndicate the type of form being submitted for the patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1343HbA1cIndicates the HbA1c value for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1344BlankIndicates the date the HbA1c value was taken for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1345Lipid Profile Total Cholesterol (TC)Indicates the Total Cholesterol (TC) value for this patient 
Patient Information / 2728 - Medical Evidence FormRQMT_1346BlankIndicates the date the Total Cholesterol value was taken for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1347LDLIndicates the Lipid Profile LDL Cholesterol (LDL) value for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1348BlankIndicates the date the LDL Cholesterol value was taken for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1349HDLIndicates the Lipid Profile HDL Cholesterol (HDL) value for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1350BlankIndicates the date the HDL Cholesterol value was taken for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1351TGIndicates the Lipid Profile Triglycerides value for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1352BlankIndicates the date that the Lipid Profile Triglycerides was taken for this patient. 
Patient Information / 2728 - Medical Evidence FormRQMT_1360Date Patient Started Chronic Dialysis at Current FacilityIndicates the date of the patient's first dialysis treatment or home training date at the facility. This date may represent the Date Patient Started Chronic Dialysis at Current Facility on the 2728. 
Patient Information / 2728 - Medical Evidence FormRQMT_1361Has patient been informed of kidney transplant options?Indicates whether or not the patient has been informed of his/her options for receiving a kidney transplant. 
Patient Information / 2728 - Medical Evidence FormRQMT_1362If patient NOT informed of transplant options, please check all that applyIndicates all the reasons why a kidney transplant is not an option for this patient at this time. User can select multiple reasons. 
Patient Information / 2728 - Medical Evidence FormRQMT_1364Name of Transplant HospitalIndicates the DBA name of the transplant hospital where the patient received a kidney transplant. 
Patient Information / 2728 - Medical Evidence FormRQMT_1365Medicare Provider Number for item 29Indicates the provider number of the transplant hospital where patient received a kidney transplant. 
Patient Information / 2728 - Medical Evidence FormRQMT_1366Name of Preparation HospitalIndicates the name of the hospital where patient was admitted as an inpatient in preparation for, or anticipation of, a kidney transplant prior to the date of the actual transplantation. 
Patient Information / 2728 - Medical Evidence FormRQMT_1367Medicare Provider number for Item 32Indicates the provider number of the hospital where the patient was admitted as an inpatient in preparation for, or anticipation of, a kidney transplant prior to the date of the actual transplantation. 
Patient Information / 2728 - Medical Evidence FormRQMT_1369Type of DonorIndicates the type of donor the kidney was received from. 
Patient Information / 2728 - Medical Evidence FormRQMT_1370If Non-Functioning, Date of Return to Regular DialysisIf transplant is nonfunctioning, enter date patient returned to a regular course of dialysis. If patient did not stop dialysis post transplant, enter transplant date. 
Patient Information / 2728 - Medical Evidence FormRQMT_1371Name of Training ProviderIndicates the name of the facility furnishing self-care dialysis training. 
Patient Information / 2728 - Medical Evidence FormRQMT_1372Medicare Provider Number of Training Provider (for item 38)Indicates the Provider Number of the training facility. 
Patient Information / 2728 - Medical Evidence FormRQMT_1373Date Training BeganIndicates the date self-dialysis training began. 
Patient Information / 2728 - Medical Evidence FormRQMT_1374Type of TrainingIndicates the type of self-dialysis training the patient began. 
Patient Information / 2728 - Medical Evidence FormRQMT_1375BlankIndicates the type of self-dialysis hemodialysis training the patient began. 
Patient Information / 2728 - Medical Evidence FormRQMT_1376This Patient is Expected to Complete (or has completed) Training and will Self-dialyze on a Regular Basis.Indicates whether or not the physician certifies that the patient has or is expected to complete the training successfully and self-dialysis on a regular basis. 
Patient Information / 2728 - Medical Evidence FormRQMT_1377Date When Patient Completed, or is Expected to Complete, TrainingIndicates the date the patient completed or is expected to complete self-dialysis training. 
Patient Information / 2728 - Medical Evidence FormRQMT_1381BlankIndicates the date that the training physician signed the form. 
Patient Information / 2728 - Medical Evidence FormRQMT_1382UPIN of Physician in Item 44Indicates the training practitioner's UPIN. 
Patient Information / 2728 - Medical Evidence FormRQMT_1383Personnel Last NameIndicates the personnel legal last name. 
Patient Information / 2728 - Medical Evidence FormRQMT_1384Personnel First NameIndicates the personnel legal first name. 
Patient Information / 2728 - Medical Evidence FormRQMT_1385DateIndicates the date that the attending physician signed the form. 
Patient Information / 2728 - Medical Evidence FormRQMT_1386RemarksContains any miscellaneous remarks (text) entered by the Physician, facility, or ESRD Network. 
Patient Information / 2728 - Medical Evidence FormRQMT_1387DateIndicates the date that the patient signed the 2728. 
Patient Information / 2728 - Medical Evidence FormRQMT_1414Current Dialysis Treatment SiteIndicates the anticipated long term treatment setting for this patient. 
Patient Information / 2728 - Medical Evidence Form / GFR -RQMT_1213GFR MethodThe lab method used to calculate the Adult GFR. This is determined by the creatinine measurement method. (lab specific) 
Patient Information / 2728 - Medical Evidence Form / GFR -RQMT_1214GFRThe Glomerular Filtration Rate is a system generated value calculated from the selected GFR lab method 
Patient Information / 2728 - Medical Evidence Form / GFR -RQMT_1215Adult GFR DefaultThe default adult GFR Lab Method that is assigned to a facility as the generally used method. 
Patient Information / 2728 - Medical Evidence Form / GFR -RQMT_1216Pediatric GFR DefaultThe default pediatric GFR Lab Method that is assigned to a facility as the generally used method. 
Patient Information / 2728 - Medical Evidence Form / GFR -RQMT_1237GFR MethodThe lab method used to calculate the Pediatric GFR. This is determined by the creatinine measurement method. (lab specific) 
Patient Information / 2746 - Death NotificationRQMT_192BlankSystem-generated form version 
Patient Information / 2746 - Death NotificationRQMT_193BlankIndicates the most recent date the patient record was submitted. 
Patient Information / 2746 - Death NotificationRQMT_1397DateIndicates the date the 2746 form was signed. 
Patient Information / 2746 - Death NotificationRQMT_1398Was patient receiving Hospice care prior to death?Indicates the patient was receiving Hospice care prior to death. 
Patient Information / 2746 - Death NotificationRQMT_1399Did transplant patient resume chronic maintenance dialysis prior to death?Indicates whether or not the patient resumed outpatient dialysis prior to death. 
Patient Information / 2746 - Death NotificationRQMT_1400Was graft functioning (patient not on dialysis) at time of death?Indicates whether or not the graft was functioning (patient not on dialysis) at the time of death. 
Patient Information / 2746 - Death NotificationRQMT_1402Type of transplant receivedIndicates the type of donor the kidney was received from. 
Patient Information / 2746 - Death NotificationRQMT_1404Date most recent transplantIndicates the date of the patient's most recent kidney transplant. 
Patient Information / 2746 - Death NotificationRQMT_1405Was discontinuation of renal replacement therapy after patient/family request to stop dialysis?Indicates the patient's treatment was discontinued at the request of the patient's family or the patient. 
Patient Information / 2746 - Death NotificationRQMT_1407Date of last dialysis treatmentIndicates patient's last treatment date if the patient discontinued renal replacement therapy. 
Patient Information / 2746 - Death NotificationRQMT_1408If yes, check one of the following:Indicates why the patient's treatment was discontinued. 
Patient Information / 2746 - Death NotificationRQMT_1410Renal replacement therapy discontinued prior to death:Indicates if the patient voluntarily discontinued renal replacement therapy treatment prior to death. 
Patient Information / 2746 - Death NotificationRQMT_1411If Yes, Specify:Indicates a secondary cause of death for this patient (Up to 4 secondary causes may be selected). 
Patient Information / 2746 - Death NotificationRQMT_1412Were there secondary causes?Indicates the patient's secondary causes of death. 
Patient Information / Admit / DischargeRQMT_354Admit DateIndicates the date of the patient's first dialysis treatment or home training date at the facility. This date may represent the Date Patient Started Chronic Dialysis at Current Facility on the 2728. 
Patient Information / Admit / DischargeRQMT_355Admit ReasonIndicates the reason a patient was admitted to care at a facility. 
Patient Information / Admit / DischargeRQMT_361Discharge DateIndicates the date that the facility discharges the patient. 
Patient Information / Admit / DischargeRQMT_362Discharge ReasonIndicates the reason a patient was discharged from care at a facility. 
Patient Information / Admit / DischargeRQMT_364Transfer Discharge SubcategoryIndicates the type of facility that the discharging facility believes will provide future care. 
Patient Information / Admit / DischargeRQMT_374StateThis field contains the patient's transient state for his / her mailing address. 
Patient Information / Admit / DischargeRQMT_375Transient AddressIndicates the transient street address of the patient. 
Patient Information / Admit / DischargeRQMT_376BlankIndicates the transient street address 2 of the patient. 
Patient Information / Admit / DischargeRQMT_377CityIndicates the transient city of the patient. 
Patient Information / Admit / DischargeRQMT_378Zip CodeIndicate the Patient's transient zip code. 
Patient Information / Admit / DischargeRQMT_379BlankIndicates the transient +4 code that follows the zip code for the patient's mailing address. 
Patient Information / Admit / DischargeRQMT_380Transient Phone NumberIndicates the patient's transient phone number. 
Patient Information / Admit / DischargeRQMT_393Submit DateIndicates most recent date the patient Admit or Discharge record was submitted. 
Patient Information / Admit / DischargeRQMT_813SSN N / AIndicates if Patient's Social Security Number is not applicable. 
Patient Information / Admit / DischargeRQMT_814Claim Number N / AIndicates if Patient's Medicare Claim Number is not applicable. 
Patient Information / Admit / DischargeRQMT_1066Patient's Self Reporting of Race and EthnicityIndicates if a patient's race and ethnicity was or was not self reported 
Patient Information / Admit / DischargeRQMT_1284Transient ReasonIndicates the reason for the patient's transient status. 
Patient Information / Admit / DischargeRQMT_1359Date Regular Chronic Dialysis BeganIndicates the date that the patient started regular course of dialysis. When admitting a patient and the admit reason = Dialysis After Transplant Failed, the Date Regular Chronic Dialysis Began represents the Date Return to Dialysis. 
Patient Information / GAP PatientsRQMT_789*Select OneAllows the user to select either an entire Network or a single facility when searching for a GAP patient. 
Patient Information / GAP PatientsRQMT_790*FilterAllows the user to select a time frame filter when performing a GAP patient search. 
Patient Information / GAP PatientsRQMT_791SettingColumn that populates the patient Primary Dialysis Setting (KDDRQMT_366). 
Patient Information / GAP PatientsRQMT_792Last FacilityColumn that populates the facility DBA name (KDDRQMT_37) a patient was admitted to prior to discharge. 
Patient Information / General - PatientRQMT_111BlankUnique identifier for patients. 
Patient Information / General - PatientRQMT_121Physical Address Same as Mailing AddressIndicates that the mailing address is the same as the physical address. 
Patient Information / General - PatientRQMT_124BlankIndicates the mailing address 2 of the patient. 
Patient Information / General - PatientRQMT_127BlankIndicates the +4 code that follows the zip code for the patient's mailing address. 
Patient Information / General - PatientRQMT_134Primary Cause of Renal FailureIndicates the ICD-9-CM code for the primary cause of end stage renal disease for this patient. 
Patient Information / General - PatientRQMT_136Primary Cause of Death CodeIndicates the patient's primary cause of death. 
Patient Information / General - PatientRQMT_390Treatment Start DateIndicates the date of first ESRD treatment (dialysis or transplant) received. 
Patient Information / General - PatientRQMT_392BlankIndicates the patient's current age if the patient is living, or age at the time of the patient's death. 
Patient Information / General - PatientRQMT_751Primary Cause of Death DescriptionIndicates the patient's primary cause of death description. 
Patient Information / General - PatientRQMT_1291Co-Morbid ConditionsIndicates all of the patient's co-morbid conditions. 
Patient Information / General - PatientRQMT_1295Death CodeIndicates the patient's primary cause of death. 
Patient Information / General - PatientRQMT_1299Cause of Death DescriptionIndicates the patient's primary cause of death description. 
Patient Information / General - PatientRQMT_1305Patient's Last NameThe patient's current legal last name. 
Patient Information / General - PatientRQMT_1306Patient's First NameIndicates the patient's current legal first name. 
Patient Information / General - PatientRQMT_1307MIIndicates the patient's current legal middle initial. 
Patient Information / General - PatientRQMT_1308Medicare Claim NumberIndicates the patient's current Medicare health insurance claim number. 
Patient Information / General - PatientRQMT_1309SSNIndicates the patient's Social Security Number. 
Patient Information / General - PatientRQMT_1310Date of BirthThe patient's date of birth. 
Patient Information / General - PatientRQMT_1311Mailing AddressIndicates the mailing address of the patient. 
Patient Information / General - PatientRQMT_1312CityIndicates the mailing city of the patient. 
Patient Information / General - PatientRQMT_1313StateThis field contains the patient's state for his/her mailing address. 
Patient Information / General - PatientRQMT_1314Zip CodeIndicate the patient's mailing zip code. 
Patient Information / General - PatientRQMT_1315Home Phone NumberIndicates the patient's home phone number. 
Patient Information / General - PatientRQMT_1316GenderThe patient's gender 
Patient Information / General - PatientRQMT_1317EthnicityThe patient's ethnicity. 
Patient Information / General - PatientRQMT_1318Country / Area of OriginIndicates the patient's country of origin or ancestry. 
Patient Information / General - PatientRQMT_1319RaceThis field contains the patient's race based on Federal racial categories. Multiple categories may be selected. 
Patient Information / General - PatientRQMT_1320Is patient applying for ESRD Medicare coverage?Select the appropriate yes or no block to indicate if patient is applying for ESRD Medicare. Note: Even though a person may already be entitled to general Medicare coverage, he/she should reapply for ESRD Medicare coverage. 
Patient Information / General - PatientRQMT_1321Current Medical CoverageIndicates the patient's current medical coverage status. 
Patient Information / General - PatientRQMT_1322HeightIndicates the most recent recorded height of the patient or if an amputee, height before amputation. 
Patient Information / General - PatientRQMT_1323Dry WeightIndicates the patient's weight post dialysis. 
Patient Information / General - PatientRQMT_1324Employment Status (6 mos prior and current status)Indicates the patient's employment status 6 months prior to renal failure. If patient is under 6 years of age, 6 months prior to the time of the current ESRD episode, leave blank. 
Patient Information / General - PatientRQMT_1325Name of Enrolled/Principal TribeIndicates the patients enrolled/principal tribe if the patient is an American Indian/Alaska Native. 
Patient Information / General - PatientRQMT_1326Did patient receive exogenous erythropoietin or equivalent?Indicates whether an Erythropoietin Stimulating Agent (ESA), such as Exogenous erythropoietin (EPO) or equivalent, was received by the patient prior to ESRD therapy. 
Patient Information / General - PatientRQMT_1327TimeframeIndicates when the patient was administered the ESA (EPO or equivalent) prior to ESRD therapy. 
Patient Information / General - PatientRQMT_1328Was patient under care of a nephrologist?Indicates if the patient was under the care of a nephrologist prior to ESRD therapy. 
Patient Information / General - PatientRQMT_1329TimeframeIndicates the time frame when the patient was under a nephrologist's care prior to ESRD therapy. 
Patient Information / General - PatientRQMT_1330Was patient under care of kidney dietitian?Indicates if the patient was under the care of a kidney dietitian prior to ESRD therapy. 
Patient Information / General - PatientRQMT_1331If Yes, answer:Indicates the time frame when the patient was under a kidney dietician care prior to ESRD therapy. 
Patient Information / General - PatientRQMT_1332What access was used on first outpatient dialysis?The vascular access information as to the type of access used (AVF, graft, catheter(including port device) or other type of access. 
Patient Information / General - PatientRQMT_1333Is maturing AVF Present?Indicates whether a maturing AVF is present while an alternate access type is being used. 
Patient Information / General - PatientRQMT_1334Is maturing AV Graft present?Indicates if the access type was not a fistula (AVF) or graft, whether or not a maturing Graft was present. 
Patient Information / General - PatientRQMT_1388Current Employment StatusIndicates the patient's current employment status. If patient is under 6 years of age, leave blank. 
Patient Information / General - PatientRQMT_1393StateContains the patient's state of physical residence. 
Patient Information / General - PatientRQMT_1394Place of DeathIndicates the location at which this patient expired. 
Patient Information / General - PatientRQMT_1395Date of DeathIndicates the patient's date of death. 
Patient Information / General - PatientRQMT_1396Modality at Time of DeathIndicates the patient's modality at time of death. 
Patient Information / Merging PatientsRQMT_1210NoneAn indicator that identifies whether a patient has been merged. The status will indicate if the patient is active or inactive after the merge or unmerge is completed. 
Patient Information / Merging PatientsRQMT_1211NoneThis indicates the date on which the patient was merged. 
Patient Information / Patient SearchRQMT_805Date of Birth: (select range or specific date)Indicates the range of patient's date of birth or a specific date. 
Patient Information / Patient SearchRQMT_806Date of Death: (select range or specific date)Indicates the range of patient's date of death or a specific date. 
Patient Information / Patient SearchRQMT_807Patients Included in SearchIndicates living, deceased, or both living and deceased patients to display in search. 
Patient Information / Patient SearchRQMT_808SIMS UPIThe SIMS UPI for patient converting from SIMS to CROWNWeb. 
Patient Information / TreatmentRQMT_365Treatment Start DateIndicates the date of the patient's treatment setting or type, which is also known as the patient's modality. This date may reflect the patient's admit date to the facility or the date that the patient's treatment type or setting has changed while under the care of the facility. 
Patient Information / TreatmentRQMT_370Attending PractitionerIndicates the attending practitioner's legal last name. 
Patient Information / TreatmentRQMT_394Submit DateIndicates the most recent date the patients treatment record was submitted. 
Patient Information / TreatmentRQMT_1355Primary Dialysis SettingIndicates the anticipated long-term treatment setting for this patient. 
Patient Information / TreatmentRQMT_1356Primary Type of Treatment Indicates the anticipated long-term primary type of treatment for this patient. 
Patient Information / TreatmentRQMT_1357Sessions Per WeekIndicates the number of hemodialysis sessions a patient receives per week. 
Patient Information / TreatmentRQMT_1358Time Per Session (in minutes)Indicates the time delivered per session for hemodialysis patients (in minutes). 
Patient Information / TreatmentRQMT_1363Transplant DateIndicates the date of the patient's most recent kidney transplants. 
Patient Information / TreatmentRQMT_1368Transplant StatusIndicates the status of the transplant. 
Patient Information / TreatmentRQMT_1389Admit DateIndicates the date the patient was admitted as an inpatient to a hospital in preparation for, or anticipation of a kidney transplant.