CROWNWeb

 

 

Add a Supplemental CMS-2728 Form

 

A Supplemental CMS-2728 Form is required when a patient has received a transplant or trained for self-care dialysis within the first three months of the first date of dialysis and the initial 2728 form was submitted.

Note:
Steps to completing a Supplemental 2728 Form are identical to completing an Initial 2728. Circumstances when required depend on the patient’s course of treatment.

To complete a Supplemental 2728 Form:

  1. From the Home screen, click the Patients link. The Search for Patients screen displays.
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  2. Enter the desired information to search for the patient, and click Search. The Patient Search Results screen displays.
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  3. Click the desired patient's CROWN UPI link. The View Patient Attributes screen displays.
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  4. Click the 2728 link. The Manage 2728s screen displays.
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  5. Click the Add 2728 button in the Eligible 2728 Forms section. The description reads "Supplemental Training". If the form passes all required validations with respect to pre-populated, read-only values, the Add an ESRD Medical Evidence (2728) screen displays.
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  6. Enter available information, and then click Save.
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  7. The message Form 2728 was saved displays. Scroll to the bottom of the screen, and click the Print button.
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  8. The Cognos Viewer screen pops up displaying the 2728 Form.
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  9. Click print. The Print screen displays.
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  10. Select the desired printer, and click OK.
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  11. Obtain the required signatures and missing data, and come back to CROWNWeb system to complete the 2728 Form.
  12. From the Home screen, click the Patients link. The Search Patients screen displays.
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  13. Enter the desired information to search for the patient, and click Search. The Patient Search Results screen displays.
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  14. Click the desired patient's CROWN UPI link. The View Patient Attributes screen displays.
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  15. Click the 2728 link. The Manage 2728s screen displays.
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  16. Click the Supplemental Training link. The View ESRD Medical Evidence (2728) - Saved screen displays.
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  17. Click the Edit 2728 link. The Manage 2728s screen displays.
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  18. Enter missing data, and then click Submit.
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2728 Notes:
If a user is finished completing the form, he/she can click Save or Submit. If the user clicks Save and the record passes validation for Saved 2728 forms, the form is stored in the database with the status of "Saved." If the user clicks Submit and the record passes validation for Submit 2728 forms, the form is stored in the database with the status of "Submit." The GFR will be calculated when the Save or Submit button is pressed. However, in order for the GFR calculation to be made upon Submit, values for the Serum Creatinine collection date for the age portion of the calculation and Race must be present. None of these values have to be present for a Save.

If the GFR is outside of the Kidney Data Dictionary (KDD)-defined acceptable range, the system generates a warning message and requests that you enter a remark in the Remarks box.

If validation for Save or Submit fails, a message is displayed that the required data are either missing or invalid and must be corrected. The fields on the form that fail validation are shown at the top of the screen indicating the field numbers containing the errors and the error descriptions.

The data entered on the screen will not save to the database until all validations are successful for either the Save or Submit action. The form cannot be submitted without valid data in the required fields. The asterisk symbol “*” next to the field means that it is a required field to save or submit the form.

  1. The View an ESRD Medical Evidence (2728) - Submitted screen displays.
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© 2018 Centers for Medicare and Medicaid Services