Dynamic List Information
Dynamic List Data
Form #
CMS 2728
Form Title
ESRD MEDICAL EVIDENCE REPORT MEDICARE ENTITLEMENT AND/OR PATIENT REGISTRATION
Revision Date
2024-06-01
O.M.B. #
0938-0046
O.M.B. Expiration Date
2026-11-30
Special Instructions
Contact your local Social Security Office for copies of this form