Opening a New Dialysis Facility in Network #15?

( Network #15 )

ESRD Network #15

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Opening a New Dialysis Facility in Network #15?

	Notify the Network of your intention to open a new unit Fill out and print the Initial Facility Info Form (pdf) then Fax to Network #15 at 303-860-8392.
	Review information from the following departments in Network #15: Quality Improvement • Patient Services • Data
As soon as you start seeing patients...
	Submit: Followup Facility Info Form (pdf - 4 pgs) Complete and Fax to NW #15 at 303-860-8392 Memo of Understanding Patient Forms as needed including the PAR, 2728, and 2746 (all found on Data page) QIPS Forms (found on Data page)
When you get your CMS letter approving your participation in the ESRD program...
	Immediately notify Network #15, and FAX a copy of this approval letter to Network #15 at 303-860-8392
Questions?
	Call Network #15 at 303-831-8818

Intermountain End-Stage Renal Disease Network, Inc.
165 S. Union Blvd., Suite 466, Lakewood, CO 80228
Phone: 303-831-8818 Fax: 303-860-8392
Toll free for patients only: 1-800-783-8818 or 1-888-777-0105

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