Dear Parent:

We are writing to invite your child/adolescent to take part in a research study at The Children's Hospital of Philadelphia. This study is designed to find children and teenagers who are at risk for a cardiac arrest, an event that causes the heart to suddenly stop beating. We are looking for healthy children/adolescents without any known heart problems.

Our study will include up to 10,000 children and teenagers in the Pennsylvania, Delaware and New Jersey areas. If you agree to let your child take part in this study, you will be able to register your child for the screening event and choose an appointment time. After the registration is complete, you will need to complete a Heart Health Questionnaire . This questionnaire will be asking you questions regarding your child's personal health history and activity levels as well as questions regarding your family history. This may take up to 10 minutes to complete on-line. You must give your permission, or consent, for your child to take part in the study; this will be done at the screening event. Click here to see a copy of the consent form.

We will ask your child to:

What are the benefits of taking part? Your child will receive heart tests and an evaluation by a Children's Hospital pediatric heart doctor. You may learn important information about your child's heart health. We will tell you right away if we find any serious heart problems or if your child needs more testing. You might not directly benefit from being in this study, but taking part in this research study may contribute to new information that will benefit other children in the future.

This study visit will take about 60 minutes. Taking part in this study is voluntary, meaning that you do not have to take part if you choose not to. Neither you nor your insurance company will be charged for any testing performed at the screening. If you have any questions, please call the doctor in charge of this study, Dr. Victoria Vetter at 215-590-1962, or the study coordinator, Noreen Dugan, R.N., at 267-426-5247.

Thank you.

Sincerely,

Victoria L. Vetter, M.D.
Division of Cardiology at The Children's Hospital of Philadelphia

Study Registration Form: Part 1

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INSTRUCTIONS

Only children/adolescents ages 5-19 years old with no known heart problems are eligible to participate in this screening.

Appointment Times: Below are the lists of appointment times for the Heart Health Screening Study. You may register up to 6 children at this time. You will be able to print this page to keep for your records. You are required to complete a questionnaire following this registration.

* indicates required fields.

Appointment Information
Contact Phone #
Contact E-mail
Choose a Screening Location
Choose an Appointment Time for Each Child/Adolescent
Child/Adolescent First Name Child/Adolescent Last Name Appointment Time
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6.
Security Challenge (please type the word(s) below)

For additional questions or problems contact: Noreen P. Dugan, R.N. at The Children's Hospital of Philadelphia, 267-426-5247 or e-mail youthheartwatch@email.chop.edu.