Appendices
Appendix A - Adverse Event Definitions
Appendix F - Quality of Life Questionnaires
EQ-5D: Please contact the UAB DCC for a copy of the EQ-5D survey
English Adult Quality of Life Questionnaire
Spanish Adult Quality of Life Questionnaire
English Adult Quality of Life Questionnaire
Spanish Adult Quality of Life Questionnaire
Appendix G - Trail Making Test (Part B)
Appendix I - Stroke Scales
Appendix J - Data Access Request
Click here for more information in regards to Data Access Requests
Appendix K - Device Brand List
Appendix M - Intermacs Users' Guide
Appendix N - Pedimacs Users' Guide
Pedimacs only. Click here for Pedimacs appendices.
Appendix O - Profiles of Advanced Heart Failure
Appendix P - Intermacs Data Collection Forms - V6.0
- Screening Log
- Demographics
- PreImplant
- Implant
- Implant Discharge
- 1 Week Followup
- 1 Month Followup
- 3 Month Followup
- 1 Year Post Cessation
- Adverse Event
- Patient Transfer
- Withdraw Consent
- Surgeons Worksheet - Implant Form
Data Collection Forms Archive
Intermacs FAQ User's Guide - updated 6/23/2022
Intermacs FAQ User's Guide - updated 6/23/2022
Appendix Q - Pedimacs Data Collection Forms
Pedimacs only. Click here for Pedimacs appendices.