ARDS Foundation of Illinois ARDS Foundation, charitable organization offers support to families/victims of Acute (Adult) Respiratory Distress Syndrome.

ARDS Survivor Registry

The ARDS Foundation is working with physicians to establish a registry of survivors of ARDS. If you have not yet signed up for our registry, please help us to establish a reliable means of determining the number of individuals, men, women, and children, who have survived ARDS.

We are asking survivors of ARDS to provide information to be included in the registry. You can do as little as list your information for purposes of the registry or as much as getting more involved in our organization to whatever extent you are comfortable.

The information provided in the registry is confidential. The ARDS Foundation does not share or sell email addresses or mailing addresses. Furthermore, by filling out this form, you will not obligate yourself to anything. When an interested physician or researcher contacts the foundation, you will then be contacted by the foundation to see if you are interested in participating in a research project involving ARDS survivors. Only then would a third party contact you. But by participating, you are beginning to make a difference!

If you are uncomfortable filling out the form online, please call us at: 312-749-7047.

Thank you.

All fields marked with * are required.

Full Name: *

Email Address: *

Telephone: *

Address: *

City: *

State: *

Zip Code: *

What year you were diagnosed with ARDS? *

What date were you admitted to the hospital? *

What date did you get released? *

How old where you when you were diagnosed with ARDS? *

What was the diagnosed precipitating cause (if you were given one)? *

Did you have sepsis, either prior to or after having been diagnosed with ARDS? * yes no

If you answered yes was it? prior after

How long were you on the ventilator? *

What hospital were you treated at? *

How long was your stay at the hospital? *

Did you go from the hospital to a rehab facility? * yes no

If so, how long?

How would you describe your lungs specifically, and your heath in general, post ARDS? *

Do you have any post ARDS effects, such as memory loss, concentration, or comprehension, emotionally, or physically? *

Comments: *

7 plus 43? *

Please add the numbers and place the answer in the box. This is a Spam prevention Contact Form question.

ARDS Foundation
3100 Dundee Road, Suite 402
Northbrook, IL 60062
PH: 312-749-7047

Eileen Rubin Zacharias, President
Paula Blonski, Vice President

The ARDS Foundation

All donations are tax deductible in the amount allowed by the law. The ARDS Foundation is a federal 501(c)(3) organization.

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