BASIC (03-86)

This notice acknowledges receipt of your report that you no longer require a regular course of dialysis. Under the law, Medicare coverage will end the last day of the 12th month after the month in which an individual was last on a regular course of dialysis unless by that time dialysis is resumed or a kidney transplant is received. We will contact you shortly before the 12th month for information about your condition at that time.

If you have any questions about your claim, you may contact any social security office. Most questions can be handled by telephone or mail. However, if you visit an office, please take this notice with you.