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Form #
CMS 2744B
Form Title
END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD FACILITY SURVEY (TRANSPLANT CENTERS ONLY)
Revision Date
2004-02-01
O.M.B. #
0938-0447
O.M.B. Expiration Date
2013-11-30
CMS Manual
N/A
Special Instructions
To obtain copies of these forms, please contact your End Stage Renal Disease (ESRD) Network (see link below)
.