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Interagency Registry for Mechanically Assisted Circulatory Support
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        • Appendix A - Adverse Event Definitions
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        • Appendix F - Quality of Life Questionaire
        • Appendix G - Trailmaking Test
        • Appendix H - Kansas City Cardiomyopathy Questionaire
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  • Protocol
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  • Appendices
    • Appendix A - Adverse Event Definitions
    • Appendix B - IRB Guidelines
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    • Appendix E - Financial Disclosure and Conflict of Interest
    • Appendix F - Quality of Life Questionaires
    • Appendix G - Trailmaking Test
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    • Appendix I - Cardiac Medication Reference
    • Appendix J - Data Access Request Form
    • Appendix K - Device Brand List
  • Printable Forms > 19 years of age at implant
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Home Manual of Operations Appendicies Appendix F - Quality of Life Questionaires
Appendix F - Quality of Life Questionaires Print E-mail


Adult 

  • English EQ-5D Questionaire
  • Spanish EQ-5D Questionaire


PediMACS

  • VAD Questionaire


English PedsQL Reports

  • Parent Report for Toddlers (ages 2-4)
  • Young Child Report (ages 5-7)
  • Parent Report for Young Children (ages 5-7)
  • Child Report (ages 8-12)
  • Parent Report for Children (ages 8-12)
  • Teen Report (ages 13-18)
  • Parent Report for Teens (ages 13-18)


French PedsQL Reports

  • Parent Report for Toddlers (ages 2-4)
  • Young Child Report (ages 5-7)
  • Parent Report for Young Children (ages 5-7)
  • Child Report (ages 8-12)
  • Parent Report for Children (ages 8-12)
  • Teen Report (ages 13-18)
  • Parent Report for Teens (ages 13-18)


Spanish PedsQL Reports

  • Parent Report for Toddlers (ages 2-4)
  • Young Child Report (ages 5-7)
  • Parent Report for Young Children (ages 5-7)
  • Child Report (ages 8-12)
  • Parent Report for Children (ages 8-12)
  • Teen Report (ages 13-18)
  • Parent Report for Teens (ages 13-18)
 
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