Dynamic List Information
Dynamic List Data
Form #
CMS 2744A
Form Title
ESRD FACILITY SURVEY (DIALYSIS UNIT ONLY)
Revision Date
2020-07-01
O.M.B. #
0938-0447
O.M.B. Expiration Date
2023-07-31
Special Instructions
To obtain copies of these forms, please contact your End Stage Renal Disease (ESRD) Network (see link below)