SADS School Risk Assessment
Parents, answer these questions (or have your child’s doctor help complete them) every few years at these times: preschool, before/during middle school, before/during high school, and before participating in organized sports. You download a printable form HERE
Patient History Questions |
Yes | No |
Has your child fainted or passed out DURING exercise, emotion or startle? | ||
Has your child fainted or passed out AFTER exercise? | ||
Has your child had extreme fatigue associated with exercise (different from other children)? | ||
Has your child ever had unusual or extreme shortness of breath during exercise? | ||
Has your child ever had discomfort, pain or pressure in his chest during exercise? | ||
Has a doctor ever ordered a test for your child’s heart? | ||
Has your child ever been diagnosed with an unexplained seizure disorder? | ||
Family History Questions |
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Are there any family members who had an unexpected, unexplained death before age 50? (include SIDS, car accident, drowning, others) |
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Are there any family members who died of heart problems before age 50? | ||
Are there any family members who have had unexplained fainting or seizures? | ||
Are there any relatives with certain conditions such as: | ||
Hypertrophic cardiomyopathy (HCM) | ||
Dilated cardiomyopathy (DCM) | ||
Aortic rupture or Marfan syndrome | ||
Arrhythmogenic right ventricular cardiomyopathy | ||
Long QT syndrome (LQTS) | ||
Short QT syndrome | ||
Brugada syndrome | ||
Catecholaminergic ventricular tachycardia | ||
Primary pulmonary hypertension | ||
Pacemaker | ||
Congenital deafness | ||
Please explain more about any “yes” answers here: |