The Young Hearts for Life®(YH4L) Cardiac Screening Program, nationally known for its unique model, has screened over 240,000 students for conditions associated with sudden cardiac death. This milestone is a first for any heart screening program of this kind in the United States. Each week, sudden cardiac death claims the lives of more than 60 young adults in the United States. YH4L has been a leader the medical community to address this problem in the Chicago area. Because of our generous donors and sponsors, we have been able to offer this screening to your child for FREE. Please consider supporting this program so we can continue to offer this to students in our area.

For more information about the YH4L program and what we offer, please visit our website at YH4L.org.

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Dear Parents/Guardians,

We are pleased to bring the Young Hearts for Life® (YH4L) Cardiac Screening Program to your student's school. All students who have proper authorization and are present the day of the screening, will be tested. Please be aware that repeat ECG testing is recommended every two years.

YH4L provides free cardiac screenings which include an electrocardiogram (ECG) and may include a screening ECHO (echocardiogram) to identify students at risk for sudden cardiac death. To date over 240,000 students have been screened as a result of YH4L. More information about the screening can be found here.

A simple ECG, when used to screen young adults can detect certain serious heart conditions. Recording the electrical activity of the heart using electrodes attached to the skin with a mild adhesive, can detect approximately 70% of the abnormalities or “markers” from these heart conditions that are associated with sudden cardiac death that a stethoscope cannot. ECG screenings result in less than 2% of the tests being falsely positive. This may require additional evaluation and testing by your physician. We believe that the benefit of this potentially lifesaving screening outweighs this concern.

We encourage you to discuss this screening with your child. Your child’s participation in the screening is your decision. We want to assure you that students’ confidentiality, privacy and individual modesty will be respected throughout all aspects of the program. Only female technicians will test girls and they will be screened in an area separate from boys. The results will only be shared with the parents/guardian. The school will not get your child’s results.

Current Testing Dates Listed Below:

 

I give permission for my child to participate in the Young Hearts for Life® Cardiac Screening in which my child will receive an electrocardiogram, and may receive an echocardiogram. An electrocardiogram (also known as EKG or ECG) is a non-invasive test that measures the electrical activity of the heart and can detect certain heart abnormalities that may lead to sudden cardiac death. An echocardiogram is a non-invasive test that uses sound waves to create a moving picture of the heart that can detect heart abnormalities.

I understand that my child’s participation in the Young Hearts for Life® Cardiac Screening is intended to identify heart abnormalities which may affect their health during physical activities. I assume all risks associated with my child’s participation in the Cardiac Screening. All such risks being known and appreciated by me and having read this waiver I hereby for myself, heirs, executors, and administrators waive any and all claims I may have for damages against Young Hearts for Life and any and all individuals associated with this screening, their heirs, representatives and successors, and assignees for any and all injuries suffered by my child in connection with this screening or any actions or omissions related to the screening even though that liability may arise out of negligence or carelessness on the part of those named in this waiver.

I understand that Young Hearts for Life® will endeavor to keep my child’s health information confidential pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its related Rules and Regulations and other state laws. I understand that my student’s results may be used, after being de-identified, for research purposes. In the event my child’s ECG result indicates that further evaluation is needed, Young Hearts for Life may contact me for additional information.

I grant permission to all the foregoing to use any photographs, recordings or any other record of this event for any legitimate purpose consistent with HIPAA and its related Rules and Regulations and other state laws.

I acknowledge that I have read this Permission Form and Waiver and understand the risks associated with my child’s participation in the Young Hearts for Life® Cardiac Screening.