CROWNWeb

 

 

Add an Initial CMS-2728 Form

An Initial 2728 must be completed for a new patient after the patient has been admitted as New to ESRD in CROWNWeb. Only one Initial 2728 form is required for a patient. This form does not require the completion of sections C and D.

Note: You must have a Serum Creatinine lab value dated within the 45 day window prior to the start date in order to complete this form. If you do not have this value, draw this lab from the patient on the start date. You will not be able to submit the Initial CMS-2728 form without this value.

To complete an Initial 2728 Form:

  1. From the Home screen, click the Patients tab. 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. 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 or select all patient information up to the Physician Identification and Obtain Signature from Patient sections, and then click Save. You will not be able to print the form unless all other required fields up to this point are complete. The View ESRD Medical Evidence (2728) - Saved screen displays.
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  7. Scroll to the bottom of the screen, and click the Print button. The Downloading screen pops up.
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  8. Click the close button. The download screen displays asking if you want to open or save the file.
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  9. Click the Open button. A pdf of the CMS - 2728 displays.
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  10. Click the printer icon. The print screen displays.
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  11. Select the desired printer, and click Print.
  12. Once the required signatures from the Attending Physician and Patient have been obtained, click the Patients tab. The Search for Patients screen displays.
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  13. Enter the patient criteria, and then 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 Initial Dialysis link. The View ESRD Medical Evidence (2728) - Saved screen displays.
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  17. Click the Edit 2728 link. The Edit an ESRD Medical Evidence 2728 - Saved screen displays.
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  18. Enter the date the Attending Physician and Patient signed the form, and any other 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 ESRD Medical Evidence (2728) - Submitted screen displays the message "View ESRD Medical Evidence (2728) - Submitted" if all information passes validation.
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