CHADS2 CHADS2 Your Name (required) Age Gender ---FemaleMale Surgery Dr Date PLEASE ENSURE YOU ANSWER ALL QUESTIONS Do you have a history of: Congestive Heart Failure ---NoYes Hypertension ---NoYes Stroke or TIA symptoms previously ---NoYes Diabetes Mellitus ---NoYes THANK YOU FOR COMPLETING THIS QUESTIONNAIRE. STAFF USE ONLY Participants NHS Number: Researchers Name: NHS Site Number: NHS Site Name: Postcode:
