The Fresenius dialysis admissions form is normally completed by your nephrologist, hospital discharge planner, or case manager and submitted to Fresenius Kidney Care through the online admissions portal at admissions.freseniuskidneycare.com, by fax to 1-877-699-5524, or by phone at 1-888-373-1470. The form is a combined intake sheet and checklist, and it only works if the required clinical documents travel with it. Knowing what goes on the form and what has to be attached is the difference between a start date in a few days and one that keeps slipping.
Who Fills Out the Form and How It Gets to Fresenius
You usually don’t fill out the admissions checklist yourself. It’s built for the referring provider to complete, with you supplying the pieces only you have: your insurance card, Social Security number, and your preferences for clinic location and shift.
There are three ways to send it in. The online portal is the fastest. A referring physician or discharge planner enters the intake information, uploads supporting documents, tracks status in real time, exchanges messages with an admissions coordinator, and uploads anything missing without starting over. If the portal isn’t workable, the referring office can download a fax cover sheet and checklist from the Fresenius website and fax the packet to 1-877-699-5524. Admissions services support is also reachable by phone at 1-866-434-2597.
If no provider is handling the referral for you, call 1-888-373-1470. A Fresenius team member can walk you through the next steps and help start the file.
What the Admissions Form Asks For
The fax cover sheet doubles as the checklist, so what’s on it is what the facility needs to open your case. It falls into three groups.
Patient and Scheduling Details
Full name, date of birth, phone number, Social Security number (if applicable), and insurance class: Medicare, Medicaid, VA, commercial, or none. The form also asks for a preferred facility or zip code and a shift preference such as morning, afternoon, MWF, or TTS. Tell your referring provider your preferences before they submit; changes after the fact slow things down.
Referring Provider Information
The referring hospital or practice name, your nephrologist’s name, and a contact person with phone, fax, and email. Fresenius uses these to coordinate medical orders and chase down records that weren’t in the initial packet.
Medical and Clinical Information
When you first started dialysis, your diagnosis (end-stage renal disease or acute kidney injury), your current modality (in-center hemodialysis, peritoneal dialysis, or home hemodialysis), and your vascular access type (fistula, graft, central venous catheter, or PD catheter). If you’re being discharged from a hospital, the form captures your discharge destination (home, hospice, or a skilled nursing or assisted living facility).
A set of clinical-status questions follows. Have you had outpatient dialysis before? Do you have capacity to consent? Do you use a LifeVest or ventricular assist device? Are you ventilator- or tracheostomy-dependent? Do you need a mechanical device for transfers? Weight is flagged for patients over 300 pounds or under 90 pounds so the clinic can assign the right chair and equipment. Infection questions cover COVID-19, Hepatitis B, multi-drug-resistant organisms (MRSA, VRE, CRE, ESBL), C. difficile, Candida auris, tuberculosis, and anything else that would require isolation.
Documents That Must Be Attached
The form alone won’t move your file. The Fresenius fax cover sheet lists the required attachments, and a missing one can hold up admission.
- Dialysis orders: current orders from your nephrologist, or the last flow sheet and treatment sheet if you’re transferring from another facility.
- Current lab report with dates: recent bloodwork showing values such as serum creatinine, hemoglobin, and albumin.
- Medication list and allergy list: complete and current, so the clinical team can avoid drug interactions during treatment.
- Hepatitis B surface antigen (HBsAg) result drawn within the last 30 days. The facility cannot seat you without it.
- Face sheet with demographics and insurance information, typically generated by a hospital or physician’s office, plus a copy of your insurance card.
- History and Physical performed within the last year. If none is available, a recent nephrology consultation note, discharge summary, or physician progress note will substitute.
- Vascular access surgical report documenting the procedure that placed your fistula, graft, or catheter.
Portal submissions take these as file uploads. Fax submissions put them behind the completed cover sheet. Either way, confirm with your nephrologist’s office or hospital medical records department that each item is ready before the referral goes out. Record requests through a patient portal or a signed release usually take a few days, so start early.
Why the 30-Day Hepatitis B Test Is Non-Negotiable
The HBsAg requirement reflects a federal rule. Under 42 CFR 494.30, dialysis facilities must follow the CDC’s infection-prevention recommendations for chronic hemodialysis patients, which call for every patient’s full Hepatitis B serologic status (HBsAg, anti-HBc, and anti-HBs) to be known before dialysis begins. If results aren’t on hand at admission, testing must be completed within seven days. Patients who test positive for HBsAg are dialyzed in a separate area with dedicated machines.
Ongoing screening is handled by the facility after you’re admitted: monthly HBsAg testing for patients susceptible to Hepatitis B, including vaccine non-responders, and annual anti-HBs checks for immune patients to confirm levels stay above 10 mIU/mL. Your initial result, though, has to come in with the referral packet.
Insurance, Medicare, and the CMS-2728
Once your packet arrives, a Fresenius insurance coordinator verifies your benefits, confirms dialysis coverage, identifies prior-authorization requirements, and flags billing issues. If a policy has lapsed or a plan requires a specific network referral, the coordinator works with you to fix it before your first session.
Most dialysis patients eventually qualify for Medicare through the ESRD provisions, even under 65 and without a disability history. Eligibility requires regular dialysis or a kidney transplant and sufficient Social Security work credits held by you or a qualifying family member. Coverage typically starts on the first day of the fourth month after treatments begin. That waiting period runs automatically whether or not you’ve applied, so file promptly through your local Social Security office or by calling 1-800-772-1213 to avoid a coverage gap.
The form that drives ESRD Medicare entitlement is the CMS-2728, the End Stage Renal Disease Medical Evidence Report. Your nephrologist and the dialysis facility complete it together, documenting diagnosis, lab values, co-morbidities, and treatment history. Both you and your nephrologist must sign it, and it must be submitted to Medicare within 45 days of your first dialysis session. An incomplete or unsigned CMS-2728 can mean denied or delayed ESRD Medicare benefits.
If you have employer group health coverage when dialysis starts, that plan stays primary for 30 months, with Medicare secondary. The clock starts the month you first become eligible to enroll in Medicare for ESRD, whether or not you sign up. After the 30 months, Medicare becomes primary. Employer size doesn’t matter: even a plan covering a single employee pays primary during that window. Your insurance coordinator tracks the timeline so Medicare is active and ready when it ends.
The coordinator also screens for additional help. Medicaid eligibility is reviewed and monitored monthly, including any spend-down amount. Patients without adequate coverage are assessed for indigent-care programs, with waiver applications completed on their behalf. The American Kidney Fund’s Health Insurance Premium Program (HIPP) can help low-income dialysis and transplant patients pay insurance premiums; you apply through your dialysis team, and your facility must be Medicare-certified for you to remain eligible.
What Happens After You Submit
The admissions coordinator checks your packet against federal requirements under 42 CFR Part 494, the Conditions for Coverage for End-Stage Renal Disease Facilities, while the insurance coordinator verifies benefits and secures any pre-authorizations. Plan on several business days for the combined review, longer if your plan needs extra documentation or if clinical records are missing. Once both clear, a staff member calls to confirm your first treatment date and time.
If something is incomplete, the coordinator will tell you (or your referring provider) exactly what’s needed. The two items that most often hold things up are the HBsAg result inside the 30-day window and the vascular access surgical report, so if you’re assembling the packet yourself, start with those.