Survivor Registry 2020-01-10T15:47:23-06:00

Survivor Registry Form

Please fill out as much you can.

Did you have a tracheotomy?

Were you also diagnosed with Sepsis? (required)

Did you have chest tubes?

Did you have any secondary infections?

Did you suffer delirium during your hospitalization?

Did you receive inpatient rehabilitation?

Days spent at inpatient rehabilitation?

Did you work prior to your ARDS diagnosis?

After your hospitalization, did you return to work? (required)

Before you were diagnosed with ARDS did you suffer from (check all that apply) (required)
anxietydepressionPTSD post-traumatic stress disordernone of the above

After surviving ARDS, did you suffer from (check all that apply) (required)
anxietydepressionPTSD post-traumatic stress disordernone of the above

After surviving ARDS, did you see a mental health care provider?

If so, did the mental healthcare provider formally diagnose you with (check all that apply)
anxietydepressionPTSD post-traumatic stress disorder

After surviving ARDS, if you suffer from anxiety, depression and/or PTSD, do you believe it is associated with your ARDS hospitalization?

Post ARDS, have you suffered from any cognitive impairment? (required)

Post ARDS, did you go home on oxygen? (required)

Post ARDS, did you have muscle and/or nerve damage? (required)

Did you see a pulmonary specialist after hospital discharge? (required)

Did you have a pulmonary function test (PFT) post ARDS? (required)