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Laao registry data collection form pdf

ICD Registry v2 - Data Collection Form - Quality Improvement for ... 2026

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The document is a comprehensive medical form detailing patient demographics, episode of care, history and risk factors, diagnostic studies, procedure information, post-procedure events, and follow-up assessments related to a left atrial appendage (LAA) occlusion intervention. It includes sections for patient identification, health insurance status, medical history including risk scores for stroke and bleeding, procedural details, intra- and post-procedure complications, medications administered, and discharge information. The form is designed to collect data for clinical evaluation and research purposes.

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Click ‘Get Form’ to open the ICD Registry v2 - Data Collection Form in our editor.
Begin with the 'DEMOGRAPHICS' section. Fill in the patient's last name, first name, middle name, and birth date. Ensure you check the appropriate boxes for race and ethnicity.
Proceed to the 'EPISODE OF CARE' section. Enter the arrival date and select the health insurance type. If applicable, provide details about payment sources.
In the 'HISTORY AND RISK FACTORS' section, answer questions regarding previous medical conditions and risk factors by selecting 'Yes' or 'No' as appropriate.
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