Name of Cardiologist
Phone Number of Cardiologist
Email address of Cardiologist
Name of Hematologist/Oncologist
Email address of Hematologist/Oncologist
Administrative Contact Person
Email of key Administrative
Phone of Key Administrative
Name of Institution
FEDERAL SCIENTIFIC AND CLINICAL CENTER, FMBA OF RUSSIA
Other (Non US)
How would you describe your institution?
RESEARCHE AND TEACHING HOSPITAL
Is your C-O program a dedicated C-O clinic?
How long has your cardio-oncology program been in operation?
On average how many C-O patients do you see each month?
Do you have any training program in C-O at your institution?
Have you become a member of IC-OS?
Did you take the IC-OS Certifying exam or did anyone at your practice?
What hematology/oncology or other subspecialties are regularly engaged with the C-O team (list the top 5)?
Oncology, Electrophysiology, Interventional Cardiology, Cardiac Imaging, Radiology, Cardiomyopathy/Heart Failure, Arrhythmia including QT prolongation, Thrombosis related toxicity