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Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome (HLHS)

Overview
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- About Hypoplastic Left Heart Syndrome (HLHS)
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Contact the Program

Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome

Mayo Clinic
Stabile Building, Fifth Floor, Room 49
200 First St. SW
Rochester, MN 55905
Phone: 507-266-6459
Email: hlhs@mayo.edu (Please use the contact form below)

Please complete form to learn more about ongoing research opportunities.

First Name

First Name must have at least 0 and no more than 30 characters.Enter a first name

Last Name

Last Name must have at least 0 and no more than 30 characters.The value of the Last Name field is not valid.

Address 1 (Street address, P.O. Box)

Address 1 (Street address, P.O. Box) must have at least 0 and no more than 256 characters.The value of the Address 1 (Street address, P.O. Box) field is not valid.

Address 2 (Apartment, suite, unit, building, floor, etc.)

Address 2 (Apartment, suite, unit, building, floor, etc.) must have at least 0 and no more than 256 characters.The value of the Address 2 (Apartment, suite, unit, building, floor, etc.) field is not valid.

City

City must have at least 0 and no more than 30 characters.The value of the City field is not valid.

State

State must have at least 0 and no more than 15 characters.The value of the State field is not valid.

Zip Code

Zip Code must have at least 0 and no more than 10 characters.The value of the Zip Code field is not valid.

Phone Number

Enter a valid telephone number.

Enter a valid email address.

Age of HLHS Patient

If you are currently pregnant with a child diagnosed with HLHS, how many weeks along are you?

Weeks

Weeks must have at least 0 and no more than 20 characters.The value of the Weeks field is not valid.

How old is the HLHS patient?

Months (patients under 1 year)

Months (patients under 1 year) must have at least 0 and no more than 20 characters.The value of the Months (patients under 1 year) field is not valid.

Years (patient over 1 year)

Years (patient over 1 year) must have at least 0 and no more than 20 characters.The value of the Years (patient over 1 year) field is not valid.

Interest

What research study are you interested in?

What research study are you interested in? must have at least 0 and no more than 512 characters.The value of the What research study are you interested in? field is not valid.

How did you hear about us?

How did you hear about us? must have at least 0 and no more than 512 characters.The value of the How did you hear about us? field is not valid.

Mayo Clinic Number

Your Mayo Clinic number is a 7, 8 or 9-digit number we assign to you as a new patient prior to your first visit. You can find it near the top of a range of documents, including pre-visit questionnaires, clinical notes, care summaries, and correspondence.

If you do have Mayo paperwork handy, it's often quickest simply to look for it there. Scroll down to see some examples of how the number shows up:

In correspondence:

Image of Form: Authorization for Mayo Clinic to Disclose Protected Health Information

In pre-appointment questionnaires

In medical documents:

In dismissal summaries:

In several other kinds of documents:

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