Reference Guide
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Identifier:
Center:
 

CENTER INFORMATION
Center:*

PATIENT INFORMATION
*
Date of Birth:* mm/dd/yyyy
Gender:*

DIAGNOSIS INFORMATION
Date of first heart failure diagnosis/assessment at this center:* mm/dd/yyyy
Was patient previously diagnosed at another institution:*
mm/dd/yyyy
Primary Diagnosis:*
 
ISHLT PEDIATRIC HEART FAILURE REGISTRY
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