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Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Screening Form
About this free form template

Screen for CTEPH After Pulmonary Embolism with Paperform

Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious but treatable complication that can develop in 2-4% of patients following acute pulmonary embolism. Early identification and referral to specialized centers significantly improves patient outcomes, making systematic screening essential for pulmonary medicine practices, cardiology departments, and specialized PE follow-up clinics.

This CTEPH Screening Form helps healthcare providers efficiently assess patients who have experienced pulmonary embolism for signs of persistent pulmonary hypertension. The form systematically captures dyspnea severity using validated scales, documents echocardiogram and imaging findings, evaluates functional capacity, and determines eligibility for pulmonary endarterectomy or balloon pulmonary angioplasty.

Built on Paperform's healthcare-focused platform, this template streamlines the screening process with conditional logic that adapts questions based on symptom severity and diagnostic results. The form automatically identifies patients who meet criteria for pulmonary hypertension specialist referral, helping your practice ensure timely access to specialized care for appropriate candidates.

For pulmonary hypertension centers and cardiothoracic surgery programs, this form provides standardized intake data that supports multidisciplinary team review and treatment planning. Integration with your EHR system via Stepper (stepper.io) enables seamless data flow, automated referral notifications, and coordinated care pathways without manual data entry.

Whether you're a pulmonologist managing PE survivors, a cardiologist evaluating unexplained dyspnea, or a PH specialist coordinating complex cases, this CTEPH screening form helps you deliver evidence-based, systematic care that catches this treatable condition before irreversible complications develop.

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