CROWNWeb

 

 

Print a CMS-2746 Form

 

All CROWNWeb users can view and print a CMS-2746 ESRD Death Notice form for a patient. A CMS-2746 form must exist in a Saved or Submitted status for the patient, and the user must have Adobe Acrobat Reader installed and configured on his/her computer to preview and print the form.

NOTE:
A copy of the completed, signed CMS-2746 Form must be stored in the patient's medical records file in accordance with the medical archival rules in effect in your state.

To print a 2746 for a patient:

  1. From the Home screen, click the Patients link. The Search for Patients screen displays.
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  2. Enter the patient criteria, and then 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 View 2746 (Submitted) or Edit 2746 link (Depends on the 2746 Form's status). The View a Death Notice (2746) screen displays.
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  5. Scroll to the bottom of the screen, and click Print button. The Downloading pop up dialog box displays.
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  6. Click Close. A dialog box displays asking if you want to Open or Save the file.
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  7. Click Open. The 2746 pdf pops up displaying the CMS - 2746 form.
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  8. Click the printer icon. The Print screen displays.
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  9. Select the desired printer, and click OK.
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