| 67878-9 | Facility name:ID:Pt:Dialysis facility:Nom: | required |
| 68330-0 | CMS certification number - CCN:ID:Pt:Dialysis facility:Nom: | required |
| 68442-3 | Dialysis setting.primary:Type:Pt:^Patient:Nom: | required |
| 68443-1 | Dialysis.primary:Type:Pt:^Patient:Nom: | required |
| 68448-0 | Dialysis sessions per W:NRat:Pt:^Patient:Qn: | required |
| 68489-4 | Dialysis Hs per session:NRat:Pt:^Patient:Qn: | required |
| 68358-1 | Date chronic dialysis began:Date:Pt:^Patient:Qn: | required |
| 68444-9 | Date chronic dialysis began at current facility:Date:Pt:^Patient:Qn: | required |
| 68360-7 | Transplant options given to patient:Find:Pt:^Patient:Ord: | required |
| 68361-5 | Reasons patient not informed of transplant option:Find:Pt:^Patient:Nom: | conditional |