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Forms

New ESRD facilities must go through several steps to be completely functional in the ESRD registry (CROWNWeb).

PRIOR to Certification (only if you are treating patients while pending final certification)

• Complete the New Facility Welcome Form
• We will use information from this form to send your Facility Welcome Packet and Network Facility Agreement to produce to State Surveyors
• Nothing additional happens until you receive your CMS certification.  Your facility may start treating self-pay patients.
• Sign up for CROWNWeb and start entering patient data (see below).
• Remember, this is only for units open and treating patients while waiting for final survey and certification.

AFTER CMS Certification

This is the sequential ‘Checklist’ that we will complete with your facility through the certification process:

• Send Qsource ESRD Network 12 a copy of your CMS certification letter
  This is the first ‘go’ step that starts everything on our side.  Please send a copy of your certification letter to us by clicking on the “Notify the Network” button to the left.
• Register in Other Systems (NHSN, DFC)
  There are several other systems that your facility will need to utilize, including NHSN and the Dialysis Facility Compare (DFC) site.  Please contact Network 12’s Data Department and we will assist you with these steps.
• Sign up for CROWNWeb and start entering patient data (see below)

Sign up for CROWNWeb:

If you are certified or pending certification and treating patients you need to sign up for CROWNWeb and enter patient data:

• Create your facility in CROWNWeb
  We will create your facility record in CROWNWeb and will notify you when complete.
• Create CROWNWeb Accounts
  After your facility is created in CROWNWeb, several key users need to be created so that you can perform tasks in CROWNWeb.  The EIDM/QARM Quick Start User Guide will provide detail instruction so that you can create your:
• • SO – You will first create your Security Official (SO) in CROWNWeb – this is the ‘manager’ that will approve other users.
  • Backup SO – You will then register your Backup SO in CROWNWeb – it is always good to have a backup!
  • End Users – Additional CROWNWeb users can be created at this point, if applicable for your facility.
  • QIP POC – One user at your facility must be identified as the Point of Contact (POC) for the annual QIP Comment Period.  This can be any person, but is usually a manager or nephrologist at your facility.
• Read and familiarize staff with the CROWNWeb Data Management Guidelines Manual.
  This is the official CMS guide that outlines CMS-required task completion in CROWNWeb.
• Training
  CMS has created a very robust training system located on the MyCROWNWEb website.  We encourage you to review on-line training modules, keeping in mind that the Heartland Kidney Network Data Department is here to assist in any way we can.
• Enter Patients into CROWNWeb and begin performing routine tasks
• Congratulations! Your Facility is Fully Functional with CROWNWeb!