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Medicine / Short QT syndrome / Hypertrophic cardiomyopathy / Cardiovascular disease / Sudden cardiac death / Long QT syndrome / Cardiomyopathy / Arrhythmogenic right ventricular dysplasia / Brugada syndrome / Cardiac dysrhythmia / Health / Cardiology


Sudden Cardiac Death Risk Assessment Form Is your child at risk? If unsure, talk to your child and/ or family members as you fill out this form. If you or your child answer “Yes” to ANY of these specific questions, y
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Document Date: 2014-10-07 16:56:41


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IndustryTerm

car accident / /

MedicalCondition

heart arrhythmia / SIDS / congenital deafness / high cholesterol / pain / Hypertrophic cardiomyopathy / Marfan syndrome / Dilated cardiomyopathy / seizures / right ventricular cardiomyopathy / high blood pressure / cardiac arrest / unexplained seizure / aortic rupture / unexplained fainting / Wolff-Parkinson-White Syndrome Heart attack / coughing / wheezing / Long QT syndrome / /

MedicalTreatment

heart surgery / /

Position

physician / /

Technology

transplantation / /

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