Treating Physician Post Report Survey Request Your Name* First Last Your Email Address* Provider & Hospital*Original Procedure Date* Date Format: MM slash DD slash YYYY Post StratX ID*Additional Procedure Date (if) Date Format: MM slash DD slash YYYY What was the reason you requested a post-treatment scan? Patient reports minimal or no improvement Clinical expected outcomes such as FEV1 or change in RV less than MCID Loss of effect Routine follow-up CT Other Was the original Chartis assessment conclusive? (ie. Did flow trend down to zero?) Yes No If not, please provide additional details regarding the Chartis assessment.What clinical questions are you seeking to answer for this patient? Amount of TLVR Potential missed airway Potential valve misplacement or mirgration Other Did you find the report helpful in answering them? Yes No CommentsWhat additional information, if any, do you wish the report provided?What was the clinical outcome based on this report? No action was taken Re-bronchoscopy, without revision procedure Re-bronchoscopy, with revision procedure and valve(s) placed Other If there was a re-bronchoscopy procedure, did what you visualize match the information in the report? Yes No If no, please explain.Any additional comments or suggestions:CAPTCHA
