SP Providers Listing

Submit Directory Listing

Amyloidosis Center Directory Form

Gravity Forms version of the SmartSheet form as created by Segiu

Center Identification

Official name of the amyloidosis center or program
Parent institution where the center operates
Department responsible for amyloidosis services (if applicable)

Fields for the marker on map

Adres

Original form address fields

Main organisational website
Public page describing your amyloidosis services

Contact information

Person authorized to respond to ISA queries about this submission
Alternate contact for updates or verification

Activity Level

Approximate total number of amyloidosis patients managed annually
Approximate number of newly diagnosed amyloidosis cases annually

Multidisciplinary Team

Required specialists essential to diagnosing and managing systemic amyloidosis. Indicate whether they work onsite or through formal referral

Hematology
Cardiology
Nephrology
Neurology
Pathology
Other specialists contributing to comprehensive care
(select all that apply)

Diagnostic Capabilities

Echocardiography
CMR
Radionuclide Imaging
Histopathology with Congo red staining
Amyloid Typing
(e.g. mass spectrometry, immunohistochemistry)
Genetic Testing
(TTR and other mutations)
Fat aspiration / labial gland biopsy
Organ Biopsies
(heart/kidney/liver/nerve/GI)
If key diagnostics are provided externally, list partner laboratories

Subtype Expertise

Indicate whether your center provides comprehensive management of the following

Subtype AL
Subtype ATTRv
Subtype ATTRwt
Subtype AA
Rare Subtypes
(Tick those managed routinely)
Brief explanation of how rare or complex subtype cases are referred or co-managed

Treatment Options

Indicate whether therapies are delivered onsite or by referral

Chemotherapy AL
TTR Stabilizers
RNA Interference
Antisense Oligonucleotides
Stem Cell Transplant
Heart Transplant
Kidney Transplant
Liver Transplant
Any additional disease-modifying or supportive treatments

Patient Support Services

Patient Support Services

Networks, Telemedicine and External Support

Do you provide telemedicine or virtual consultation services?
Are you part of a formal amyloidosis network?
Do you perform diagnostic services (including typing) for other organisations?
Participation in national or regional amyloidosis networks

Education and Research

Answers in this section will not be displayed in the directory or influence listing.

Do you provide amyloidosis training for physicians within your institution?
Types of amyloidosis research conducted
List active and past amyloidosis clinical trials
Do you provide amyloidosis training for physicians outside your institution?
Would your institution be interested in hosting an ISA Fellowship?

ISA Relationship

Answers in this section will not be displayed in the directory or influence listing.

Are any of your amyloidosis experts members of ISA?
This information is collected for statistical purposes only and does not affect eligibility.

Attestations and Declarations

Answers in this section will not be displayed in the directory.

Accuracy, authority and update commitment
I confirm that the information provided is accurate and complete. I am authorized to submit this information on behalf of my institution. I agree to notify ISA of material changes and to update this information at least annually.
Publishing
I consent to ISA publishing the information in the public ISA Amyloidosis Center Directory.
Policy
I have read and accept the ISA Amyloidosis Center Directory Policy.
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