Record the number of chronic hemodialysis patients who received hemodialysis at your center on the first two working days of the month. Count each patient only once. If a patient has both an implanted access (graft or fistula) and a catheter, count this patient as having the catheter.
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Facility ID# :
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*Location code:
| *Month:
| *Year:
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*Vascular Access Type
| *Number of Chronic Hemodialysis Patients
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Fistula
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Graft
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Tunneled central line
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Nontunneled central line
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Other access device (e.g., hybrid access)
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*Total patients (sum of all patients listed above)
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