Form: MUGA or Echocardiogram
| Question | Response |
|---|---|
| Date of assessment | |
| Method | |
| LVEF Result | |
| LVEF Unit | |
Form: Electrocardiogram
| Question | Response |
|---|---|
| Date Performed | |
| Subject position | |
| PR Interval (msecs | |
| QRS Interval (msec | |
| QT Interval (msecs | |
| QTc Interval (msec | |
| Heart Rate (cycle/ | |
| ECG Result Interpr | |
| Specify ECG Abnorm |