- Form #
- CMS 2744B
- Form Title
- END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD FACILITY SURVEY (TRANSPLANT CENTERS ONLY)
- Revision Date
- 02/01/2004
- O.M.B. #
- 0938-0447
- O.M.B. Expiration Date
- 08/31/2013
- CMS Manual
- N/A
- Special Instructions
- To obtain copies of these forms, please contact your End Stage Renal Disease (ESRD) Network (see link below)
