PCQLI

Lurie Hospital

Download PCQLI Forms - Access Request

Please fill out the form on this page to request access to download the PCQLI Forms. Within a few minutes of placing your request, you will receive an email containing a download link to access the PCQLI Forms.

User Information

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Context of PCQLI Use

Individual clinical practice (Expected duration of use):

Mode of administration:

Type of research:

Research funding

Funding source:

If US Funding (Please check all that apply):

PCQLI Terms and Conditions

The Pediatric Cardiac Quality of Life Inventory (PCQLI) is a non-profit HRQOL measure for pediatric cardiac patients with acquired or congenital heart disease. The PCQLI is copyrighted by Ann & Robert H. Lurie Children’s Hospital of Chicago (“Lurie Children’s”).

No fee is charged for using the PCQLI. However, you are required to register and abide by the following to be authorized to use the PCQLI. Your registration and acquisition of the PCQLI User Guide and Forms signifies your full agreement to be legally bound by the following terms and conditions:

  1. You agree to acquire and use the PCQLI only for non-profit, non-commercial, research and clinical purposes.
  2. You agree to acknowledge the PCQLI in any publications that result from your acquisition and use of the PCQLI.
  3. You shall not modify, abridge, condense, translate, adapt, recast or transform the PCQLI questionnaires in any manner or form, including but not limited to any minor or significant change in wordings or organization in PCQLI questionnaires, without the prior written agreement of Lurie Children’s.  If permission is granted, any improvements, modifications, or enhancements to the PCQLI which may be conceived or developed, including translations and modules, shall become the property of Lurie Children’s.
  4. You shall not reproduce the PCQLI questionnaires except for the limited purpose of generating sufficient copies for use in the above mentioned clinical investigations and shall in no event distribute copies of the PCQLI questionnaires to third parties by sale, rental, lease, lending, or any others means.
  5. You shall be solely responsible and assume all risk and liability for your acquisition and use of the PCQLI.
  6. You shall make no claim against Lurie Children’s related to your acquisition and use of the PCQLI and agree to indemnify and hold Lurie Children’s harmless against any and all claims related to your acquisition and use of the PCQLI.
  7. YOU UNDERSTAND THAT THE PCQLI IS BEING PROVIDED AS IS, AS AVAILABLE BASIS, WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT.