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Category  Term Definition
Case Info
1-800-MEDICARE Medicare   Hotline
Network Actions 5-Diamond The 5-Diamond Patient Safety Program is a series of training modules designed to help dialysis facilities to increase safety awareness and build a culture of safety among patients and staff.
IVD/IVT 30 Day Letter Letter sent to the patient notifying them that they will be Involuntary Discharged or transferred to another facility.
IVD/IVT 30 Day Letter Date Date of the 30 Day letter.
Case Info # Activities Defaults to 0. System generated count of the number of activities in the log.
Areas of Concern Abusive A concern about any words (written or spoken) that have the intent to demean,   insult, belittle or degrade facility or medical staff, patient   representatives, patients, families or others.
Areas of Concern Access Site Issues A concern about issues related to the patient's vascular or peritoneal access site, such as infiltration, numerous sticks, prolonged post-dialysis bleeding, use of clamps, tunnel infection, exit site infection, evaluating for stenosis, etc.
Case Info Access to Care Indicates that the case type is related to Access to Care which could include   Behaviors, Medical Needs or Facility Refusal.
Case Info Address The patient's and or person calling on the grievant mailing street address.
Case Info Address 2 The patient's and or person calling on the grievant mailing street address.
Network Actions Adherence Toolkit A compilation of tools and resources created to help facilities improve adherence and patient compliance.
Network Actions Advocated for Patient Rights Promoted and supported patient rights as described in the Conditions for Coverage.
Case Info Affiliation An alternative company or facility who owns the facility that was not included   in the standard list of affiliations.
Access to Care Alcohol, Drug Abuse or Withdrawal A concern that an individual is, or is suspected of being, under the influence of alcohol or other drugs at treatment. This may result in behaviors that are perceived as disruptive, dangerous, or threatening as a result of intoxication or withdrawal during treatment.
Areas of Concern Alcohol/Drug Abuse/Withdrawal A concern that an individual acknowledges that he/she is under the influence of   drugs or alcohol or an individual is suspected of being under the influence of alcohol or other drugs at treatment. This may result in behaviors that are perceived as disruptive, dangerous, or threatening as a result of   intoxication or withdrawal during treatment.
Case Info Anonymous Person submitting the contact asked for name to be withheld or did not/would not   supply their name when asked.
Case Info Appointed Patient Representative An Appointed representative is an individual appointed by a court of competent   jurisdiction to act on a patients behalf or an individual who is otherwise authorized under applicable law to act on a patients behalf, or an individual appointed by a competent patient who provides authorization to act on their behalf either verbally or in writing. The Network shall request a written authorization using J-8A-1; and will file it with the records for the   case if received. An Appointed representative does not usurp the grievant' s   rights, unless the grievant is cognitively unable to interact with the Network.
Network Actions Assisted patient with Options/Interventions/Self Advocacy Skills/Pt Rights and   Responsibilities Provided help to patient/family to address and resolve grievances and/or coached   patient on patient empowerment, rights and responsibilities, and different methods to address issues and resolve conflicts.
Network Actions Assisted Staff with Patient Options/Interventions Provided staff with ways to coach patient on different methods to address issues and   resolve conflicts.
IVD/IVT At Discharge/Transfer Indicates the patient's disposition at Discharge/Transfer.
IVD/IVT At Discharge/Transfer Date Indicates the patient's disposition at Discharge/Transfer Date.
General At Risk for Involuntary Discharge An “At Risk” patient, is one in which the Network is notified that a patient is   in danger of being discharged from a facility in accordance with the ESRD CfCs, but no involuntary discharge process has been initiated and no 30-day discharge letter has been given to the patient. This includes all facility consultations with the Network regarding a specific patients disruptive   behavior. A Network shall not accept anonymous patients as “at risk".
Case Info At-Risk Access to Care Indicates that the patient is at risk to receive or has a barrier to the access of   care.
Case Info Authorized Patient Representative An individual appointed by a court of competent jurisdiction to act on a patients behalf or an individual who is otherwise authorized under applicable law to act on a patients behalf.
Areas of Concern Building Repair A concern that the building in which dialysis services is furnished is not constructed and/or maintained to ensure the safety of the patients, the staff and the public.
Case Info Caller Type Indicates the type of caller making the grievance.
Case Info Case # Application generated number tied to case.
General Case Coordinator When the Network refers a grievance to the State Survey Agency (SA), the Network will identify an individual to coordinate communication, problem-solving, and   resolution with all involved parties to avoid duplication of effort. The Network may also play a coordinating role after making a referral to another agency or organization.
Case Info Case Start Date field. Populate with the date the grievance behavior or situation began.
Case Info Case Status Defaults to Open. Additional values include: Pending Written, Referred and Closed.
Case Info Case Type Dropdown that has what type of case the grievance is related to.
Case Info CCN The dialysis facility's CMS Certification Number (CCN), the identification number   that is linked to the facility's Medicare provider agreement, where the   patient is receiving care.
IVD/IVT Chemical Dep./Abuse Reported Indicates if the patient has a history of chemical dependency or abuse.
Case Info City The patient's and or person calling on the grievant city.
Areas of Concern Clinical Competency A concern about the medical/dialysis experience and capabilities of a staff   member.
Case Info Clinical QOC A review conducted by the Network in response to a concern that (a) the rights   of two or more ESRD patients may have been violated and/or (b) that ESRD services received from a Medicare-certified provider did not meet professionally recognized standards of clinical care and/or professional   conduct and that the failure to meet recognized standards potentially resulted in an adverse clinical outcome for more than one patient.
Areas of Concern Clinical Quality of Care-RN Review Required A review conducted by the Network in response to a concern that (a) the rights   of two or more ESRD patients may have been violated, and/or (b) that ESRD services received from a Medicare-certified provider did not meet professionally recognized standards of clinical care and/or professional conduct and that the failure to meet recognized standards potentially   resulted in an adverse clinical outcome for more than one patient.
Case Info CMS Central Office An employee of CMS, Central Office.
Case Info CMS COR The Contracting Officer’ Representative
Access to Care Co-Morbidities A concern regarding the presence of one or more psychiatric or physical illnesses in addition to ESRD.
Network Actions Coached Patient on communication techniques Provided information, instruction, and/or encouragement to patient/family on methods of interacting appropriately and effectively with others.
IVD/IVT Cognitive Deficit Reported Indicates if the patient has a history of cognitive deficit problems.
Areas of Concern Communication/Miscommunication  Issues A concern about inappropriate and/or poor verbal/nonverbal interactions between   staff and patient or staff to staff, such as slow to respond or not listening to the patient, not providing explanations for treatments or procedures performed.
Network Actions Conducted Follow-Up Calls Initiated additional contact to check on situation after case ready to be closed.
Case Info Confidential A grievance in which the grievant' s identity is known to the Network but the grievant does not give permission for his/her identity to be disclosed to the provider and/or practitioner(s) involved in the grievance.
Case Info Contact Email The primary contact personnel's preferred e-mail address.
Network Actions Contacted   Medical Director Had   verbal or written interaction with Medical Director.
Network Actions Contacted   State Agency Initiated   interaction with the State Survey Agency.
IVD/IVT Coordination Indicates that the Network coordinated with the State Survey Agency for the Notification reason.
Network Actions Copies   of patients interdisciplinary reassessments Network received documentation that the Medical Director/Attending Physician at the   facility attempted to resolve the patient's problems.
Access to Care Corporate Denial of Admission/Does not meet facility Clinical Reqs Due to the facility's organizational affiliations, policies or practices, patient attendance or treatment is denied.
IVD/IVT CROWNWeb Event Confirmed Indicates the event was confirmed in CROWNWeb.
Case Info Date Closed Date field. Populate with the close date.
IVD/IVT Date Facility Notified Network Date the facility notified the Network of the Involuntary Discharge.
IVD/IVT Date of Anticipated Discharge Date that the anticipated discharge is expected to occur.
IVD/IVT Date of Last Treatment Date patient last received treatment at the specific facility.
Case Info Date Open Automatically populated with current date.
Network Actions Date Received Indicates the date the Network received documents from the facility.
Network Actions Date Requested Indicates the date the Network requested documents from the facility.
Access to Care Dementia A concern related to an overall decline in intellectual function, including difficulties with language, simple calculations, planning and judgment, and motor (muscular movement) skills as well as loss of memory (as defined by the Diagnostic and Statistical Manual of Mental Disorders [DSM]). It is sometimes   accompanied by emotional
disturbance and behavioral changes.
Case Info Description Summary description of the case.
IVD/IVT Discharge Averted Aversion occurs in a situation in which an “At Risk”, IVD or IVT patient's   previous circumstances have been resolved, and the patient will stay in its   current facility.
IVD/IVT Discharge Averted Date Date that the discharge was averted.
Network Actions Discussed   Addiction/Withdrawal/Alcohol Withdrawal Addressed issues related to alcohol/drug addiction and withdrawal, which could include information/education of symptoms and suggestions for addressing related   issues.
Network Actions Discussed Coping Skills Provided patient with information, instruction, and/or suggestions on techniques to   assist with coping with a chronic illness or other conditions.
Network Actions Discussed Depression Addressed depression and its symptoms and/or provided education and suggestions for intervention.
Network Actions Discussed Mental Health Evaluation and Follow Up Addressed issues related to mental health and/or mental illness and/or provided   education/suggestions for working with mental health issues.
Network Actions Discussed Other Modalities Indicates if the facility discussed with the patient other dialysis treatment types.
Areas of Concern Disruptive A concern regarding an individual's behavior that negatively impacts the operation of the facility, the environment, and/or the treatment given to other patients.
Areas of Concern Disruptive Family Members A concern regarding the behavior of a relative of the patient that negatively   impacts the operation of the facility, environment, and/or the treatment given to the patient or to other patients.
Patient Info DOB The patient's date of birth.
Network Actions Documentation of attempting to relocate patient Network received documentation that the facility is trying to relocate patient to   another facility that would better suit their needs.
Network Actions Documentation of fac. Notifying State Survey Agency Network received documentation that the facility notified the State Survey Agency of   concerns regarding patient.
Network Actions Documentation of fac. Unable to meet pt. medical need Network received documentation that the facility was not capable of meeting the needs of this specific patient.
Network Actions Documentation of Medical Director approval Network received documentation that the Medical Director approved patient   discharge/transfer.
Network Actions Documentation of ongoing problem and efforts to resolve Network received documentation that the Medical Director/Attending Physician at the   facility attempted to resolve the patient's problems, but were unsuccessful.
Access to Care Does   not have  an AV Fistula Facility will not accept patient due to not having or refusing placement of an   arteriovenous fistula.
Patient Info DOFD The date of first ESRD treatment (dialysis or transplant) received.
Network Actions Educated on Anger Management Provided information/instruction on need for or techniques to manage the behavioral   responses to anger.
Network Actions Educated on Coping Strategies Provided staff with information/instruction/suggestions on techniques to assist patient with coping with ESRD and/or other medical conditions.
Network Actions Educated on End of Life Hospice Provided information or instruction on hospice and/or ways to address end of life.
Network Actions Educated Staff Instructed, trained or informed staff.
Case Info Email The email address for the caller making the grievance.
Network Actions Emergency Preparedness Network-specific resources, KCER resources, as well as CMS and other federal resources.
Patient Info Employment Status (Required for Inv. Discharge at Time Network Notified) The patient's current employment status.
Case Info ESRD Network An employee of an ESRD Network Organization.
Patient Info Ethnicity Indicates the patient's ethnic background; relating to or characteristic of a human   group having racial, religious, linguistic and certain other traits in   common.
Case Info Facility Address 1 The facility's mailing street address.
Case Info Facility Address 2 The facility's mailing street address.
IVD/IVT Facility ceases to operate (CfC) A facility no longer provides any patient treatment, either voluntarily or as a   result of regulatory action.
IVD/IVT Facility Cited Indicates if the facility was cited from the State Survey inquiry.
Case Info Facility City The city in which the facility's mailing address is located.
Case Info Facility Concerns Indicates that the patient/staff have concerns related to the facility.
Case Info Facility Employee An employee of a dialysis or transplant unit.
Case Info Facility Fax The facility's main fax number.
Access to Care Facility is Full A concern regarding access to or continuation of treatment as a result of   facility capacity limitations.
IVD/IVT Facility may not be able to meet medical needs (CfC) A  facility does not have sufficient staff and/or special non-dialysis equipment   required to provide safe and effective care for the patient; for example,   patients with morbid obesity, tracheotomy, psychiatric instability, dementia.
Case Info Facility Name The  dialysis facility's Doing Business As (DBA) name where the patient is   receiving care. The name under which your facility does business; can differ   from the Legal Name of the facility.
Case Info Facility Phone The facility's main phone number.
Areas of Concern Facility Policies/Procedures A concern about facility rules and procedures and how they affect the patient   treatment and/or quality of care. This may include not enforcing policies consistently or not following procedures consistently. Issues could include not being able to eat or drink during treatment, visitor policy, not   providing or following grievance policy, not following isolation policy, not adhering to staffing guidelines, etc.
Case Info
Facility State The state in which the facility's physical address is located.
Case Info Facility Zip The zip code of the facility's physical address.
Network Actions Facility's discharge and transfer policy/procedure Network's request of the facility's policy/procedure on how to handle patient   discharges and transfers.
Network Actions Facility's patient rights and responsibilities document Network's request of the facility's patients rights and responsibilities document.
Areas of Concern Failure to Place A situation in which no outpatient dialysis facility can be located that will accept an ESRD patient for routine dialysis treatment; this includes situations in which a transient patient has not yet been registered at any   dialysis facility. An involuntary discharge may, but does not necessarily, lead to a failure to place.
Case Info Fax The fax number the caller making the grievance.
Case Info Federal Agency If the Network determines that a grievance raises an alleged or potential fraud or abuse issue, the Network will refer the grievance to the state or federal agency responsible for the investigation of fraud or abuse in the Medicaid or Medicare Program.
Case Info First Name The patient's and or person calling on the grievant first name.
Patient Info First Name The patient's current legal first name.
IVD/IVT Follow-up Indicates the patient's follow-up disposition.
Case Info Follow-up Checkbox indicating a follow up is required.
IVD/IVT Follow-up Date Indicates the patient's follow-up disposition Date.
Patient Info Foreign National Person who resides in the US, but is not a citizen, and does not have a visa or   green card.
Access to Care Former Prisoner A concern regarding access to or continuation of treatment as a result of   ex-offender status.
Patient Info Gender The gender of the patient.
Case Info General Grievance Indicates that the case type is related to general grievances for the patient.
Areas of Concern General/NOS Indicates a general grievance of the individual.
General Grievance A written or oral communication from an ESRD patient, and/or an individual   representing an ESRD patient, and/or another party, alleging that an ESRD   service received from a Medicare-certified provider did not meet the   grievant’ s expectations with respect to safety, civility, patient rights, and/or clinical standards of care. The grievant is not required to explicitly state that the care did not meet professionally recognized standards.
IVD/IVT Grievance Referral - Questionable Discharge Indicates that the Network did a grievance referral with the State Survey Agency for   the Notification reason because of the questionable discharge from that   facility.
General Grievant An ESRD patient or other individual who files a grievance with a   Medicare-certified ESRD provider or the ESRD Network.
Network Actions Healthcare Agreements/Contracts Sample goal-setting documents created to assist facilities in the writing process by   providing a content outline or customized text options.
Case Info Hm Phone The patient's and or person calling on grievant home phone number.
Access to Care Homeless A  concern regarding access to or continuation of treatment as a result of being undomiciled, lacking a permanent address or lacking HUD homelessness status certification.
Network Actions Identified   Providers for Patient Provided   information about dialysis/transplant providers for patient.
IVD/IVT If Discharge or Transfer was not Averted, did the Networks facilitate Patient Placement? Indicates if the Networks facilitated placement of the patient to another facility.
Case Info Immediate Advocacy The grievant may be either anonymous or confidential. Should the Network determine that the IA cannot be processed without the grievant providing his/her name then an anonymous grievance is not possible. The grievant may provide his/her name and request confidentiality in all Network communication with the other parties involved in the grievance investigation.
IVD/IVT Immediate severe threat (CfC) A patient physically harms or is reasonably perceived as threatening significant and imminent physical harm to other persons in the facility or who brings weapons or illegal drugs into a facility. An angry verbal outburst or verbal abuse is not considered to be an immediate severe threat.
Areas of Concern Infection Control A concern regarding the policies and procedures used to minimize the risk of   spreading infections in the dialysis facility.
Areas of Concern Infestation A concern about the presence of bugs, rodents, etc.
Access to Care Infestation (i.e. Bedbugs) A concern regarding a patient who has to have treatment separate from other   patients to prevent the spread of an infestation.
Network Actions Intervention Comment Any miscellaneous remarks (text) from the Physician, facility, or ESRD Network   recording the intervention.
Access to Care Involuntarily Discharged A   concern regarding a patient who has been immediately terminated from the   dialysis facility or has been given a letter with a date when services at   that facility will be terminated.
Areas of Concern Involuntary Discharge A situation in which, consistent with 42 CFR §494.180(f), a patient is informed in writing that treatment at a dialysis facility will terminate in 30 days or the dialysis facility notifies the Network and SA that it is following an abbreviated termination procedure for a patient who has made an immediate severe threat of physical harm.
Areas of Concern Involuntary Transfer A situation in which a patient who is registered to receive dialysis treatment   at one dialysis facility is dissatisfied with being transferred to another dialysis facility when the transferring facility temporarily or permanently ceases to operate or exist, due to a merger, an emergency or disaster   situation, or other circumstances. See 42 CFR §§494.70(b) and 494.180(f).
Network Actions IVD Process Document outlining the Conditions for Coverage standards and procedure for the   involuntary discharge of patients and the individual roles and responsibilities in the process.
Network Actions KDQOL A specific compilation of tools and resources created to measure patient function and well-being. The results can assist patients in identifying problem areas and guide improved outcomes.
Access to Care Lack of Payment/Lack of Insurance Refusal to submit payment or misrepresentation or termination or lack of coverage on the patient's part.
Access to Care Language   Barrier A concern regarding access to quality treatment because of limited English   proficiency or comprehension.
Case Info Last Name The patient's and or person calling on the grievant last name.
Patient Info Last Name The patient's current legal last name.
Network Actions Lost to Follow Up The patient has stopped arriving for scheduled treatments with no prior   notification.
Network Actions Lost to Follow Up Date The patient has stopped arriving for scheduled treatments with no prior   notification date.
Network Actions Medical Director and attending physicians signed order Network received documentation that the Medical Director/Attending Physician at the   facility approved the relocation/discharge of patient.
Access to Care Medically Unstable  A concern regarding a patient characterized by uncertain or inadequate response to treatment and the potential for unfavorable outcome, due to a medical condition or disease.
Areas of Concern Mental Health A concern related to an individual's diagnosed lack of emotional and   psychological stability regarding his/her ability to use cognitive and emotional capabilities, function in society, relate to others, make choices, handle stress, meet the ordinary demands of everyday life when the individual exhibits psychiatric issues impacting ability to adhere to the treatment   plan.
Access to Care Mental Health Issues Suspected/Diagnosed  A concern related to an individual's diagnosed lack of emotional and   psychological stability regarding his/her ability to use cognitive and emotional capabilities, function in society, relate to others, make choices, handle stress, meet the ordinary demands of everyday life when the patient exhibits psychiatric issues impacting ability to adhere to the treatment   plan.
IVD/IVT Mental Health Prob. Reported Indicates if the patient has a history of mental health problems.
Patient Info Middle Initial The   patient's current legal middle initial.
Areas of Concern Misc 1: Any miscellaneous remarks (text) from the Physician, facility, or ESRD Network.
Areas of Concern Misc 2: Any miscellaneous remarks (text) from the Physician, facility, or ESRD Network.
Areas of Concern Misc 3: Any miscellaneous remarks (text) from the Physician, facility, or ESRD Network.
Patient Info Misc. Any miscellaneous remarks (text) from the Physician, facility, or ESRD Network.
Areas of Concern Missed Facility Appointments A concern that patient has missed at least one set treatment, meeting or appointment at the facility, including those set for home dialysis patients.
Areas of Concern Missed Treatment A concern that patient has not attended scheduled treatment(s).
Areas of Concern Misses Vascular Access Appointment or Refuses to Schedule Vascular Access Evaluation A concern that patient does not agree to make an appointment, does not keep or   reschedule the missed appointment with a vascular surgeon to be evaluated for an AV fistula, or misses/ does not reschedule any vascular access related appointments.
Access to Care Morbid Obesity A concern regarding the morbid obesity of patient, which can be defined as the   incidence of a Body Mass Index (BMI) rating of over 40. BMI is measured by   multiplying weight in pounds by 704.5, then dividing by height in inches   squared. This is not a measurement of body fat, only a ratio determined by this formula.
Access to Care Multiple Units Denying Admission More than one dialysis facility or more than one dialysis organization refuses to accept patient for treatment.
Access to Care Needs Isolation A concern regarding a patient who has to have treatment separate from other   patients to prevent the spread of infectious disease, due to a disease that could be spread through the air and/or by contact.
Access to Care Needs stretcher A concern regarding a patient who requires transportation and/or dialysis in a lying position.
Network Actions Network Specific Tools Provided link(s) to Network-specific tool (exclusive of links individually highlighted in this section).
Access to Care No Accepting Nephrologist(s) Inability to secure nephrologists to manage patient's care and as a result, the facility is unable to admit the patient.
Access to Care No Permanent Access Due to Primary Vascular Access Type A concern regarding access to treatment as a result of not having or refusing evaluation for or placement for a fistula.
Areas of Concern Noise A concern that the sounds in the facility are disturbing or a source of frustration. This could include televisions that are too loud, staff that are   talking or laughing loudly, machines that beep, etc.
Access to Care Non-Adherence Noncompliance with or nonconforming to medical advice, facility policies and procedures, professional standards of practice, laws and/or socially accepted behavior toward others.
Access to Care Non-Medicare Patient does not yet have Medicare coverage or has not had previous coverage.
IVD/IVT Non-Payment (CfC) Refusal to maintain or, if eligible, apply for coverage or misrepresentation of coverage, including failure to countersign and surrender private insurance checks made payable to patient for dialysis services and/or inability to apply for benefits due to citizenship status.
Access to Care Not Enough Staff to Handle Patient A concern that there is insufficient staff to adequately provide quality care for patients during treatment.
IVD/IVT Notification Reason Indicates the Notification reason of:
Coordination
Grievance Referral –Questionable Discharge
IVD/IVT Notification Reason Date Date of Notification reason.
Access to Care Nursing Home Resident A concern regarding a patient who lives in a long-term care facility.
Network Actions Offered ESRD Network Mediation Indicates that the Network offered to assist the patient/grievant in resolving the   issues/concerns with the facility.
Access to Care On Ventilator A concern regarding a patient who requires a medical machine designed to mechanically move breathable air into and out of the lungs if physically unable to breathe or breathes insufficiently.
IVD/IVT Ongoing disruptive and abusive Behavior (CfC) Disruptive: A regular history of behaviors by patient that significantly impairs the operation of the facility, environment, and/or the treatment given to other patients. In addition, behavior which involves a
regular history of behaviors by the patient   that are expressed in writing, spoken words or actions, reasonably perceived as demeaning, dangerous, violent and/or threatening to the health and safety of anyone within the facility.
IVD/IVT Ongoing disruptive and abusive behavior by a family (Invalid under CfC) Disruptive: A regular history of behaviors by family member that significantly impair the   operation of the facility, environment, and/or the treatment given to other patients. In addition, abusive behavior which involves a regular history of behaviors by family member that are expressed in writing, spoken words or actions, that are reasonably perceived as demeaning, dangerous, violent  and/or threatening to the health and safety of anyone within the facility.
Network Actions Other Any other remarks (text) from the Physician, facility, or ESRD Network.
Areas of Concern Other Clinical/NOS Indicates that the grievance is related to other clinical not specific.
Access to Care Other Medical Needs A concern about medical needs for any other reason.
Network Actions Participated in Care Conference Attended virtually, by conference call or in person a meeting regarding the care of a   patient.
Case Info Patient An individual receiving ESRD services from a Medicare-certified dialysis   facility or transplant center. ESRD patients who are not Medicare   beneficiaries have the same rights as Medicare beneficiaries in all processes   related to grievances and patient-appropriate access to care.
Case Info Patient Advocate The Patient Advocate is someone the patient may contact to help them file a grievance, but then has to be made an Appointed or Authorized representative with the CMS form.
IVD/IVT Patient at Risk for Indicating the patient is as risk, with a related dropdown to identify if the risk is for IVD or IVT.
Network Actions patient discharge or transfer notice Indicates if the Network requested notification of the discharge or transfer of the patient.
IVD/IVT Patient Discharged Indicates if the patient is discharged.
Access to Care Patient Hygiene A  concern regarding patient's cleanliness of body and clothing as well as healthy living conditions and habits.
Areas of Concern Patient Safety/Health Issues A concern regarding the protection of and wellbeing of the patient related to treatment patient/staff interactions, and care.
Areas of Concern Physical Environment A concern related to the condition or safety of the facility.
Access to Care Physical Harm Any bodily harm or injury, or attack upon facility or medical staff, their   representatives, patients, families or others.
Areas of Concern Physical Threat A concern regarding any bodily harm/ injury or attack upon facility or medical   staff, their representatives, patients, families or others.
Case Info Physician or Other Practitioner An individual credentialed in a recognized health care discipline who provides   the services of that discipline to patients.
Areas of Concern Physician Order A concern that staff is not following nephrologists’ medical prescription or   prescription is not ordered. For example, medications not administered, lab tests not completed, treatments shortened, EDW not evaluated, and incomplete, inappropriate or outdated standing orders, etc.
Areas of Concern Physician Relations/Physician Competence A concern or dissatisfaction with the physician/patient interactions. For example, this could include the belief that the physician does not respond to the patients request, behaves inappropriately, does not adequately explain the treatment plan, and/or may not be easily accessible to the patient who has questions or concerns.
Network Actions PIP End Date Documents the end date related to facilities placed on performance improvement plans.
Network Actions PIP Restart Date Documents the restart date related to facilities placed on performance improvement plans.
Network Actions PIP Start Date Documents the start date related to facilities placed on performance improvement plans.
IVD/IVT Post Discharge Follow-Up Indicates the patient's disposition at Post Discharge or Follow-Up.
IVD/IVT Post Discharge Follow-Up Date Indicates the patient's disposition at Post Discharge or Follow-Up Date.
Areas of Concern Prescribed Treatment Not Followed (Diet/Medications) A concern that patient has missed at least one set treatment, meeting or appointment at the facility, including those set for home dialysis patients.
Areas of Concern Primary Area of Concern Indicates detailed information about the specific areas of concern for that specific   case.
Patient Info Primary Ins. Indicates the patients primary coverage for insurance.
IVD/IVT Prior Inv. Discharge Reported Indicates if the patient had a prior involuntary discharge reported.
Areas of Concern
Professionalism A concern about the way staff interacts with patients/family members or one another. The staff does not uphold its professional ethics and boundaries and may exhibit rudeness, disrespect, and a lack of sensitivity, inattentiveness to patient needs.
Areas of Concern Property Damage A concern regarding theft or damage to property on premises of dialysis facility or transplant center.
Access to Care Property Damage or Theft Theft or damage to property on premises of ESRD facility.
Access to Care Psychiatric Diagnosis on Chart A concern that there is a diagnosed mental illness in the medical chart.
Case Info QIO An employee of a Quality Improvement Organization.
Network Actions Quality of Life A compilation of tools and resources created to promote emotional and physical   health, emotional well-being, and other factors related to an improved lifestyle or quality of life.
Patient Info Race Indicates the patient's race(s) based on Federal racial categories. This is a   classification of humans into large and distinct populations or groups by factors such as heritable characteristics or geographic ancestry, but also often influenced by and correlated with traits such as appearance, culture, ethnicity, and socio-economic status. Frequently genetic markers are used and is based on Federal racial categories.
IVD/IVT Reason for At Risk Date Indicates the date of reason for risk of being discharged or transferred.
IVD/IVT Reason for Discharge Date Indicates the date the patient was being discharged or transferred.
Network Actions Referenced DPC Materials Recommended all or part of the Dialysis Patient Provider Conflict (DPC) Toolbox.
Areas of Concern Referral Indicates that the patient is a referral.
Network Actions Referral Type Referral of the case to another entity. Specifically where the patient was referred to is identified under the Network Actions sub-tab with a checkbox and related   drop-down field to identify one of the following:
•Referral to the State
•Transportation Company
•Insurance Company
•Office of Civil Rights
•Other
Network Actions Referred to ESRD Website(s) for PT.Ed. Provided link(s) to ESRD sites including any Network site, CMS site or affiliated sited for material related to patient education.
Access to Care Refused Psychiatric Referral A concern that the patient did not agree to have an evaluation for the   diagnosis and treatment of a mental or emotional disorder.
Areas of Concern Refused Treatment Procedures A concern that patient will not allow or follow a specific prescribed treatment  procedure/process to be performed/completed, such as allowing medical procedures (such as refusing to be weighed, not allowing blood pressure to be  taken, not using gloves, etc.)
Areas of Concern Repeated Verbal Abuse A concern about repeated use of any words (written or spoken) that have the intent to demean, insult, belittle or degrade facility or medical staff, their representatives, patients, families or others.
Network Actions Reported Failure to State Indicates the date that the facility was reported to the state.
Case Info Resolution Text field to populate the resolution of the case.
Case Info Response Letter Date field. Populate with the date a response letter was sent.
Network Actions Results Documents the dates and results related to facilities placed on performance improvement   plans.
Network Actions Reviewed Care Agreement Examined care agreement (behavioral contract) and provided comments and suggestions as needed.
Network Actions Reviewed CfCs Discussed Centers for Medicare & Medicaid Services (CMS) Conditions for Coverage.
Areas of Concern Sanitary Conditions A concern about the cleanliness of the dialysis/transplant facility.
Areas of Concern Scheduling Issues A concern about the treatment schedule for dialysis, often related to the availability of an appointment for dialysis or that the treatment schedule is not being adhered to consistently.
Access to Care Severe Physical Limitations A concern regarding access to treatment or continuation of treatment as a result of substantial body limitations (such as limitations in dexterity or ambulation) that require major assistance or accommodation.
Areas of Concern Sexual Harassment A concern regarding unwanted and offensive sexual advances or of perceived sexually offensive remarks or acts.
Areas of Concern Shortened Treatment/Late for Treatment A concern that patient does not stay for the entire prescribed dialysis treatment or arrives late for treatment.
Areas of Concern Staff Relations Indicates that the grievance is related to the facility staff.
Areas of Concern Staff-Related A concern regarding the behavior of or interactions with the dialysis/transplant staff.
Areas of Concern Staff/Patient Ratio A concern that there is insufficient staff to adequately provide quality care   for to patients during treatment.
Case Info State The patient's and or person calling on the grievant state.
Case Info State Survey Agency An employee of the State Survey Agency.
IVD/IVT State Survey Investigated Indicates if the state survey has investigated the facility.
IVD/IVT State Survey Notified Date the State Survey Agency was notified.
Network Actions Suggested Interventions Proposed actions that could be taken to influence positive outcomes or prevent   undesirable consequences.
Areas of Concern Supplies/Equipment A concern about supplies and/or equipment related to dialysis treatment. This may include malfunctioning machines, changes in available supplies, shortage of supplies, changes in dialyzer size, changes in catheter covers, gloves, gauze/tape for holding site, and changes is dialysis administered medication  (e.g. ESAs).
Case Info Survey Checkbox indicating a Satisfaction Survey target.
Areas of Concern Temperature A concern about the temperature within the facility and/or that reasonable   accommodations for the patient have not been made.
Network Actions Template Letters Sample letters created to assist facilities in the writing process by providing customized text options.
IVD/IVT Termination by Physician – medical noncompliance (CfC) A physician acts upon the right to end an established care relationship with a patient after repeated attempts to educate the patient regarding the need to follow medical regimen and no other physician at the facility will accept the patient.
IVD/IVT Termination by Physician no show (CfC) After repeated attempts to educate the patient regarding the need to follow the   medical regimen, a physician acts upon the right to end an established care relationship due to patient's repeated failure to attend treatments and/or notify staff of their intended absence and no other physician at the facility will accept the patient.
IVD/IVT Termination by Physician – other (CfC) A physician acts upon the right to end an established care relationship with a   patient after repeated attempts to educate and work with the patient in areas other than medical adherence issues and no other physician at the facility will accept the patient.
Case Info Total   Time Defaults to 0. System generated sum of the time spent in minutes as captured in   activities.
Access to Care Tracheotomy A concern regarding a patient who has a tracheotomy, which is a surgical procedure in which a cut or opening is made in the windpipe (trachea) when enough air is not getting to the lungs or if there are problems with mucus and other secretions getting into the windpipe because of difficulty   swallowing.
Areas of Concern Transportation Issues Indicates the patient has concerns or unreliable transportation issues.
Network Actions Treatment Options Provided patient/family with information about treatment methods.
Areas of Concern Treatment Related/Quality of Care A concern involving the acceptable standard of care (safe, effective, patient-centered, timely, equitable care) or quality patient outcomes.
Access to Care Tube Feeding A concern regarding a patient who requires nutrients to be delivered through a tube directly into the gastrointestinal tract, usually into the stomach or small intestine.
Access to Care Undocumented Immigrant A concern regarding access to or continuation of treatment as a result of   lacking official credentials required to enter, live or work in a country.
Case Info User ID Automatically populated with the User ID of the user currently logged into the system.
Access to Care Verbal/Written Abuse Any words (written or spoken) with intent to demean, insult, belittle or degrade   facility or medical staff, patient representatives, patients, families or   others.
Access to Care Verbal/Written Threat Any words (written or spoken) expressing intent to harm, abuse or commit violence   directed toward facility or medical staff, patient representatives, patients, families or others.
Areas of Concern Voluntary Transfer A situation in which a dialysis patient initiates or agrees to a transfer to  another dialysis facility to receive short- or long-term outpatient dialysis treatment.
Areas of Concern Weapon Threat A concern that there may be a danger that an object designed to inflict injury may be used.
Case Info Wk Phone The patient's and or person calling on grievant work phone number.
Case Info ZIP Code The patient's and or person calling on the grievant zip code.