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Facility Closure Form

CMS 2728 Form

Man filling out form

Per CMS requirements, all CMS 2728 Forms must be submitted within 45 days of the patient's first outpatient ESRD treatment. 

CMS 2728 Form Facts for Patients - NEW September 2025

Best Practices for Timely Submission of CMS Forms - Updated July 2025

CMS 2728 Signature Guide - Update May 2025

Contact list
  • Patients
    • How We Help Kidney Patients
      • How We Help Kidney Patients
      • Complaint and Grievance Process
      • Patient Rights and Responsibilities
    • About Kidney Disease
      • About Kidney Disease
      • Keeping on Your Treatment Schedule
      • Treatment Options
        • Treatment Options
        • Hemodialysis
        • Home Dialysis
        • Kidney Transplant
          • Kidney Transplant
          • Understanding Kidney Transplant
        • Peritoneal Dialysis
        • Choosing Not to Dialyze
    • Living Well
      • Living Well
      • Employment for Kidney Patients
      • Caregivers
      • Contacts
      • Diet
      • Emergency Preparedness
      • Exercise
      • Mental Health
      • Preventing Infections
      • Shared Decision Making
      • Traveling
      • Understanding Medicare Costs
    • Working with Us
      • Working with Us
      • Consumer Committee
      • Patient Subject Matter Experts
    • Find A Provider
      • Find A Provider
      • Medicare Care Compare
  • Providers
    • How We Help Providers
      • How We Help Providers
      • Recommended Treatment Goals
      • Staff Support Resources
    • Quality Improvement Projects
      • Quality Improvement Projects
      • Home Dialysis
      • Reducing Hospitalizations
      • Vulnerable Populations
      • Equity in Healthcare
        • Equity in Healthcare
        • CLAS
        • Social Drivers of Health (SDOH)
      • Transplant
      • Depression
      • Patient & Family Engagement
        • Patient & Family Engagement
        • Complaints & Grievances
        • Employment & Vocational Rehabilitation
        • Involuntary Discharge
        • Peer Mentoring
      • Vaccinations
      • COVID-19
        • COVID-19
        • Testing
        • Vaccination
        • Administrative Considerations
        • Infection Control
        • Telehealth
        • Patient Education
        • Staff Education
        • Mental Health
        • Screening Fatigue
    • EQRS
      • EQRS
      • Data Quality Measures
      • Transplant Providers
      • CMS 2728 Form
      • CMS 2746 Form
      • CMS 2744 Form
    • Emergency Preparedness
      • Emergency Preparedness
      • Planning
      • Contacts
      • Baxter - Post Hurricane Information
    • Facility Membership Agreement
    • Master Account Holder
    • Patient Safety
      • Patient Safety
      • Preventing Infections
      • Immunization
      • NHSN
      • Care Transitions
    • Regulatory Information
      • Regulatory Information
      • Conditions for Coverage
      • Quality Incentive Program
    • Resources
    • Chronic Kidney Disease
  • About
    • About
    • Organizational Structure
      • Organizational Structure
      • Board of Directors
    • Scope of Work
    • Staff
    • Annual Report
  • News & Events
    • News
    • Events
    • E-Newsletters
      • 2025
      • 2024
      • 2023
      • 2022

Midwest Kidney Network

1360 Energy Park Drive, 

Suite 320

St. Paul, MN 55108

(800) 973-3773 For Patients

(651) 644-9877 For Providers

(651) 644-9853 Fax

info@midwestkidneynetwork.org

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Please do not send patient-specific data (name, SSN, DOB, etc.) to Midwest Kidney Network via email as this is a CMS Security Violation and will be reported as such. You may only use the EQRS ID/UPI # when referencing a patient via email message to Midwest Kidney Network.