End Stage Renal Disease Death Notification (CMS-2746)

The primary purpose of the ESRD Death Notification is to collect demographic characteristics and cause of death regarding an ESRD patient. It is to be completed within 2 weeks of the date of death of an ESRD patient. If the patient was a dialysis patient, the dialysis facility last responsible for the patient’s maintenance dialysis (or home dialysis) must complete this form. If the patient was a transplant patient, the transplant center is responsible for completing this form.

The latest form for End Stage Renal Disease Death Notification (CMS-2746) expires 2022-11-30 and can be found here.