Registration

“NIC/ WARIS QUESTIONNAIRE”

Name

First Name *

Last Name *

Hospital *

Phone *

City *

1) WHAT % OF YOUR ANGIOS DO YOU DO TRANS- RADIAL *<20%20 to 50%50 to 70%70 to 90%>90%

2.WHAT % OF YOUR PTCA DO YOU DO TRANS- RADIAL *<20%20 to 50%50 to 70%70 to 90%>90%

3.WHAT % OF YOUR PRIMARY PTCA DO YOU DO TRANS- RADIAL *<20%20 to 50%50 to 70%70 to 90%>90%

4.WHAT % OF YOUR PTCA DO YOU DO DISTAL TRANS- RADIAL *<20%20 to 50%50 to 70%70 to 90%>90%

Twenty Twenty-Five

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