| 67869-8 | Reason for medicare entitlement:Type:Pt:^Patient:Nom: | required |
| 67870-6 | Patient information - end stage renal disease form 2728:-:Pt:^Patient:-: | |
| 67871-4 | Patient demographics - end stage renal disease form 2728:-:Pt:^Patient:-: | |
| 68996-8 | Laboratory - end stage renal disease form 2728:-:Pt:^Patient:-: | |
| 67877-1 | End stage renal disease patients in dialysis treatment - end stage renal disease form 2728:-:Pt:^Patient:-: | |
| 67883-9 | Transplant information - end stage renal disease form 2728:-:Pt:^Patient:-: | |
| 68451-4 | Self-dialysis training program - end stage renal disease form 2728:-:Pt:^Patient:-: | |
| 68462-1 | Physician information - end stage renal disease form 2728:-:Pt:Provider:-: | |
| 67868-0 | End stage renal disease medical evidence report, medicare entitlement &or patient registration - OMB CMS form 2728:-:Pt:^Patient:-: | |