Reference Guide
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Identifier: 01CN012
Center: 01CN01-Royal Victoria Hospital

CENTER INFORMATION
Center:*

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

DIAGNOSIS INFORMATION
Date of First Heart Failure Diagnosis:* mm/dd/yyyy
Primary Diagnosis:*
Specify:*
CHD (check all that apply):*
  Specify:*
 
ISHLT PEDIATRIC HEART FAILURE REGISTRY
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