ESRD Monthly Dialysis Comprehensive Note (MCP)

Patient: [Patient full name], [DOB], [MRN]

Facility: [Facility name], [City/State]; Modality setting: [in-center / home]

Modality & Schedule: [in-center HD / home HD / PD (CAPD / APD)]; [Days per week]; Typical treatment duration: [hh:mm]

Month Covered: [Month YYYY: mm/dd/yyyy–mm/dd/yyyy]

Clinician: [Clinician name], [MD / DO / NP / PA]

MCP Compliance

(List all face-to-face dialysis rounding encounters performed during the covered calendar month. Add or remove rows as needed.)

Date	Setting	Clinician
[mm/dd/yyyy]	[Dialysis facility chairside / Home dialysis clinic / Other outpatient]	[Name, credentials]
[mm/dd/yyyy]	[Dialysis facility chairside / Home dialysis clinic / Other outpatient]	[Name, credentials]

Required access exam completed on: [mm/dd/yyyy] — [Vascular access exam / PD catheter exit-site exam]

Attestation: I attest that a comprehensive monthly dialysis assessment was performed and the interdisciplinary plan of care was reviewed and updated across core domains (adequacy, access, anemia, CKD-MBD, volume/BP) during the month covered.

Partial-month responsibility: [Not applicable / Applicable: coverage from mm/dd/yyyy to mm/dd/yyyy due to hospitalization / provider change / facility transfer] (Only include if applicable.)

Interval History

[Interval events, dialysis tolerance, adherence patterns, and patient-reported concerns] (Summarize in 3–6 sentences: hospitalizations, ED visits, infections, access procedures, transfusions; tolerance issues such as intradialytic hypotension or cramping; missed/shortened treatments and interdialytic weight gain trends; patient concerns. If outside records are unavailable, state pending and when reconciliation will occur.)

Objective

Vitals/Weights: [Pre/post BP summary, weight trends, current EDW, typical UF volume] (For PD, include therapy adherence metrics and UF volumes.)

Labs: [Adequacy (Kt/V or URR), Hb, TSAT/ferritin, Ca/Phos/PTH, K, bicarb, albumin — with dates and prior month comparators as relevant] (If key labs are pending, explicitly state pending rather than omitting or inferring adequacy.)

Exam:

• Vascular access (HD): [Inspection findings, thrill/pulse on palpation, bruit character on auscultation; functional indicators including blood flow rate, pressure trends, cannulation issues]
• PD catheter (PD): [Exit-site appearance, tunnel tract exam, effluent characteristics]
• [Other pertinent system findings if examined and relevant]

Assessment & Plan

(Address each core dialysis domain with current status and specific plan.)

Adequacy: [Current metric vs target; contributing factors; prescription changes if indicated]

Vascular Access: [Exam summary and functional performance; infection concerns; plan for surveillance, intervention, or catheter reduction]

Anemia/Iron: [Hb trend; current ESA and iron regimen; adjustments planned; patient-specific target approach]

CKD-MBD: [Mineral lab interpretation; current binders, vitamin D, calcimimetics; changes and monitoring plan]

Volume/BP: [EDW appropriateness; BP control pattern; antihypertensive timing; target EDW and BP range for coming month]

Nutrition: [Albumin trend; dietitian follow-up needs]

Transplant Status: [Referred / Evaluation in progress / Waitlisted / Deferred with reason if not pursuing]

Psychosocial: [Adherence barriers; social work involvement if indicated] (Include only if relevant factors identified.)

Orders & Follow-up

Medication changes: [ESA, iron, binders, vitamin D, antihypertensives — with effective dates]

Prescription modifications: [Dialysis prescription changes — with effective date]

Referrals: [Access imaging/intervention, transplant, dietitian, social work, other as indicated]

Labs ordered: [Tests and timing]

Follow-up: [Next dialysis rounding; next monthly MCP note date]