The training certification is to be executed and dated only after the patient has
either entered in or completed the training program. Unless FO final adjudication
is possible, the certification is sent (along with the application and other proofs
of R-HI eligibility, if these have not already been forwarded) to ODO for review and
adjudication.
If the form has already been submitted without training information to establish current
ESRD entitlement and, within the qualifying period the claimant enters into a self-dialysis
training program, the facility need only complete a supplemental form containing the
identification of the patient (name, HIC/SSN, date of birth, sex) and the self-care
certification — “Supplemental” will be written at the top of the form. Otherwise,
the entire form (except for transplant information) must be completed.