The Semi-Annual Patient Census Report is generated by the Network office from data stored in the SIMS repository. This data is submitted to our office on Medical Evidence Report Forms (CMS 2728s), ESRD Death Notification Forms (CMS 2746s), and monthly Patient Activity Reports. This semi-annual report is designed to verify the accuracy of the information that was submitted and that is currently listed in SIMS.
Items to remember when completing this report:
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Review and change any incorrect information. If you add or delete a patient we must have a date. Without a date, we cannot make the change in our database.
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Please make your changes with a red pen .
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Verify the Social Security Numbers.
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When adding a Medicare number, make sure to include the BIC (A, B, T, etc.)
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Do not list health insurance numbers other than Medicare.
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D o not include patients who have been at your center less than 30 days.
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Please remember that this report will be returned to you if all the necessary fields are not completed.
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This report must be returned (MAILED) to the Network office.
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Please do not fax this report.
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Before you make any changes, please review the instructions included for reminders, appropriate field entries, and descriptions. When you have completed the necessary changes, mail the Patient Census Report to the Network office.
Please do not fax this report!
Please remember that this is a required Network report and it will be tracked for receipt. If the deadline poses a problem or if you have any questions, please call us at 804.794.3757 and ask to speak with someone in the Data Department.
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1527 Huguenot Road Midlothian, VA 23113 804.794.3757 marc@nw5.esrd.net Patient Toll Free 866.651.6272
