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Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this...

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NEWS “It’s great to be alive - and to help others!” Simple Things of Life Here we are in June 2018, like most of you it is hard to believe this year is half over. Whether you are young or old, we all ask, where has the time gone? Summer has always been my favorite time of the year. School is out and that means pools are open and we hear the lakes and rivers call- ing us. Each of us could look back at our childhood and think of good simple memories. We live in such a fast pace world today, we have forgotten the simple things of our youth. Sometimes I think we’ve forgotten how to find joy in the simple things, the quiet things, that don’t require an app, an itinerary, a reservation, a ticket or a computer. Let us think of good simple memories that take our breath away as we walk through the day. I believe that some of the most unforgettable experiences are the ones that are done on the spur of the moment and the least amount of preparation. is summer take time to enjoy the simple things. Put down the iPhone, turn off the television, stay off the computer, take a walk in the neighborhood and spend time with the people you love and enjoy the unplanned adventures of simple life. Cookeville has so many free adventures and activities for the young and old this summer. Please take advantage, as we all know this can help with our health, besides we might make some new friends. We all know we need to make friends, we never know when we might help them or they might help us. We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum- mer to all of you and get out and smell the roses! Visit our website www.mendedhearts127.org From The President Reaching Out.... Mended Hearts reaches out to people from many surrounding counties. Cookeville Regional Medical Center is truly Regional. Reminder MAY YEAR TO DATE 32 Surgeries 141 45 Stents 210 5 Defibs - ICD 32 10 Pacemaker - PPM 52 10 Ablation 47 5 EP Study 14 1 TVAR 7 104 Hrs Worked 550 17 Heart Surgery Visits 84 22 Stents Visit 118 4 PPM Visits 25 2 ICD Visits 17 4 Ablation Visits 20 15 Family Visits without Patient 85 1 TVAR Visits 6 65 Total Visits 350 Submitted by Blanche Smithers Place heart healthy recipes and articles in the box provided. We encourage everyone to submit articles including the source and your name. CHARTERED MARCH 1997 - CHAPTER 127 AWARD WINNING NEWSLETTER Heart JUNE 2018 MENDED HEARTS CHAPTER 127 • COOKEVILLE, TENNESSEE VOL. 16 NO. 6 Deadline Mended Hearts meets the ird ursday of each month! June 21, 2018 THANK YOU anks to Susan Ashburn for a great presentation on strokes. Also thanks to everyone who helped make our bake sale a success. CRMC EMPLOYEES ARE HAPPY According to a survey CRMC employees are happy and believe they make a difference for patients. Mended Hearts agrees. CONDOLENCES It is with great sadness that we announce our close friend and colleague Gus Littlefield has passed away. His roles included current Treasurer, past President, Regional Director, Assistant Regional Director, Board Member and Chapter leader. NEXT MEETING Our next meeting will be ursday, June 21 at 6:00 pm in Education Rooms 2, 3 & 4 with potluck. Our speaker will be Margaret Arseniadis, CEO of Tennessee Heart. Thought For The Day Anyone who says sunshine brings happiness has never danced in the rain.
Transcript
Page 1: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

NEWS“It’s great to be alive - and to help others!”

Simple Things of LifeHere we are in June 2018, like most of you it is hard to believe this year is half over. Whether you are young or old, we all ask, where has the time gone? Summer has always been my favorite time of the year. School is out and that means pools are open and we hear the lakes and rivers call-ing us. Each of us could look back at our childhood and think of good simple memories. We live in such a fast pace world today, we have forgotten the simple things of our youth.

Sometimes I think we’ve forgotten how to find joy in the simple things, the quiet things, that don’t require an app, an itinerary, a reservation, a ticket or a computer. Let us think of good simple memories that take our breath away as we walk through the day. I believe that some of the most unforgettable experiences are the ones that are done on the spur of the moment and the least amount of preparation. This summer take time to enjoy the simple things. Put down the iPhone, turn off the television, stay off the computer, take a walk in the neighborhood and spend time with the people you love and enjoy the unplanned adventures of simple life.

Cookeville has so many free adventures and activities for the young and old this summer. Please take advantage, as we all know this can help with our health, besides we might make some new friends. We all know we need to make friends, we never know when we might help them or they might help us.

We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer to all of you and get out and smell the roses!

Visit our websitewww.mendedhearts127.org

From The President

Reaching Out....Mended Hearts reaches out

to people from manysurrounding counties.

Cookeville RegionalMedical Center

is truly Regional.

Reminder

MAY YEAR TO DATE32 Surgeries 14145 Stents 2105 Defibs - ICD 3210 Pacemaker - PPM 5210 Ablation 475 EP Study 141 TVAR 7104 Hrs Worked 55017 Heart Surgery Visits 8422 Stents Visit 1184 PPM Visits 252 ICD Visits 174 Ablation Visits 2015 Family Visits without Patient 851 TVAR Visits 665 Total Visits 350

Submitted by Blanche Smithers

Place heart healthy recipes and articles in the box provided. We encourage everyone to submit

articles including the source and your name.

CHARTERED MARCH 1997 - CHAPTER 127

AWARDWINNINGNEWSLETTERHeartJUNE 2018 MENDED HEARTS CHAPTER 127 • COOKEVILLE, TENNESSEE VOL. 16 NO. 6

Deadline

Mended Hearts meets the Third Thursday of each month!

June 21, 2018

THANK YOUThanks to Susan Ashburn for a great presentation on strokes. Also thanks to everyone who helped make our bake sale a success.

CRMC EMPLOYEES ARE HAPPYAccording to a survey CRMC employees are happy and believe they make a difference for patients. Mended Hearts agrees.

CONDOLENCESIt is with great sadness that we announce our close friend and colleague Gus Littlefield has passed away. His roles included current Treasurer, past President, Regional Director, Assistant Regional Director, Board Member and Chapter leader.

NEXT MEETINGOur next meeting will be Thursday, June 21 at 6:00 pm in Education Rooms 2, 3 & 4 with potluck. Our speaker will be Margaret Arseniadis, CEO of Tennessee Heart.

Thought For The DayAnyone who says sunshine brings happiness has never danced in the rain.

Page 2: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

May Highlights

After the meeting was called to order, birthdays were recognized and we enjoyed the potluck dinner. Our speaker was Susan Ashburn, Stroke Pro-gram Coordinator with CRMC. She talked about the heart and diabetes connection with having a stroke and also some other factors. She told us to remember the word FAST, F is for face, A is for arms, S is for speech and the T is for time (observe the time when the symptoms begin and call 911).

Baked goods were brought to the meeting. After the meeting the baked goods were taken to the Algood room and set-up for the sale the following morning.

1. Having trouble getting those annoying barcode stickers off something? Rubbing a cloth soaked in vinegar will instantly remove it, including the goo it leaves be-hind.

2. The wasps are already out! Fill a con-tainer with vinegar, sugar and salt to trap wasps. Place these around the yard this year. Use 6 oz. of vinegar, 2 tablespoons of sugar and 1 teaspoon of salt. If you need more, just double the ratio.

Tip of theMonth

From Our Kitchen to Yours

Tip of the Month

Get Heart-Healthy with Yummy Overnight Oats!Better your blood pressure with Blueberry Banana Oats!

Mix blueberries with chia seeds, rich in pressure-lowering omega 3s and a banana, loaded with blood-pressure lowering potassium, to help your heart beat with ease!

½ cup rolled oats1/3-cup almond milk1 Tbs. chia seeds ¼ cup frozen blueberries1 Tbs. sliced almonds½ banana

Add oats, milk, chia seeds and blueberries to lidded container; stir well. Top with almonds and banana. Place lid on jar; refrigerate overnight.

Jamestown SatelliteJamestown Satellite, Chapter 127 met at Jamestown Regional Medical Center on May 22 with Sharon Parris presid-ing. Pizza was served along with other good foods. An interesting round table discussion was held about a lady who passed away and was brought back to life after 45 minutes. A miracle!!!! Twelve people attended. Next meeting will be June 26 at JRMC at 6:00 pm with speaker Susan Ashburn from Cookeville Regional Medical Center Stroke Unit.

Prevent heart disease with Spiced Apple Oats!

Apple’s polyphenols help prevent hardened arteries. This recipe gets an extra anti-inflammatory boost from cinnamon. Paired with fiber-rich oats, this hearty meal keeps your heart young!

½ cup rolled oats1/3-cup vanilla almond milk1 Tbs. chopped walnuts1 tsp. ground cinnamon1 Tbs. honey¼ cup diced applesPinch ground cinnamon

Add oats, milk, walnuts, cinnamon and honey to Mason jar or lid-ded container; stir well. Top with apples and cinnamon. Place lid on jar; refrigerate overnight.

Page 3: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

G When you were first asked to run for president what did you think?

B “When first asked to be president my answer was no. I thought I cannot do that. My husband Pharoah was president at the time of his death and Denny had so graciously taken over. I wanted Denny to be president but he declined, and no one else would take it. Pharoah loved and had worked so hard on Mended Hearts I could not let him and the members down. I finally said yes, but I would need a lot of help.”

G How many hours a week do you spend on Mended Hearts matters?

B “I have never actually counted the hours I spend a week work-ing with Mended Hearts, but I can tell you today I spent from 8 a.m. to 3 p.m. doing hospital work for Mended Hearts - four hours visiting at the hospital, then to the hospital Foundation to ask for help, then to the print shop to pick up the health fair board and then to Cardiac Rehab to talk to Debbie – that’s about seven hours today.”

G What would you tell others about Chapter 127 that they don’t know and that you have worked at since you became president?

B “Chapter 127 is a great group of people. Lots goes on behind the scenes that most of our members never know. Just a few of the things are grant writing, health fairs, presenting AEDs, creating bulletin boards, writing newsletter articles, working with the print shop, talking with Administration. This does not even touch the surface.”

G How does the support from the members of Chapter 127 affect what is done at the hospital and overall?B “Chapter 127 is no different from other organizations; there is

only a hand full of members who help with everything. I have a great board of directors I could not do without. We need mem-bers to volunteer if only for one project to help take the load off of the rest. We are good, but with everyone else’s help, we could be better.”

G Are there things you would like to see done that members could help with?

B “Yes, volunteering to help with health fairs and the bulletin board each month in the waiting room. We desperately need help with these things.”

G How much interaction does the president of Mended Hearts have with the hospital staff and how does this affect the visi-tors program and other things?

B “I have a lot of interaction with the hospital staff. Almost every day I will see someone in Administration concerning a problem or just to make a personal contact to keep in touch to make sure we are doing our job well. The hospital staff is always

willing to see and talk to me at any time. The hospital staff are jewels.”

G What would you tell folks that being involved in Mended Hearts helps them as well as others?

B “I think being involved with Mended Hearts is a tremendous blessing coming from the heart. I have met so many wonder-ful people that has given me a great outlook on life. I believe we help heart patients and their families with that personal touch from someone who has been through what they are going through.”

G To be a member of Mended Hearts does a person have to have had heart problems of any kind?

B “No. We are not only wanting to help heart patients but to educate others about heart disease. You do need to be interested in helping others.”

G How can you, as president, along with others encourage our members to get more involved?

B “I wish someone could tell me the answer to that question. I have begged and pleaded for members to get more involved and it is not working. Please find it in your heart to help us.”

G How does the national Mended Hearts help or work with the different chapters across the United States?

B “I don’t know about other chapters but sometimes I find it diffi-cult to get answers about certain questions. But I do eventually get my questions answered.”

G If you could change anything that is being done to our chap-ter to make it better, what would it be?

B “To get more of our members involved in helping with different projects. As I mentioned before, a hand full of people seem to do it all.”

G What do you see in the future for Chapter 127?B “I would like to see Chapter 127 grow in numbers and also see

someone else be president. I have loved being president, but maybe someone else who has new ideas to help us grow and get more people involved.”

“It’s great to be alive - and to help others!”

Spotlight On Blanche SmithersSubmitted by: Glee Miller

Spotlight is designed to feature various Mended Heart’s members and hospital

staff. Watch Out! You could be next!

Page 4: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

The Rising Number of Elder Orphans: Ideas for LivingPagesMag0718

The Mysterious Origin of a Summer FavoritePagesMag0718

Americans will chow down on 7 billion hot dogs this summer, most never wondering about the origin of the strangely shaped sandwich with the odd name. Nonetheless, in case someone asks, here are some clues from the National Hot Dog and Sausage Council.

Hot dogs might be an invention of college wags. One of the first confirmed written references comes from a Yale maga-zine in 1895 in which students are described as “contentedly munching hot dogs.” In fact, a hot dog vendor’s cart was called The Kennel Club.

Some say the hot dog was popularized by a cartoonist, Tad Dorgan, during the 1930s when he saw his friend Harry Stevens selling the “hot dachshund sausages” during a game at the New York Polo Grounds and shouting “Get your red-hot dachshund sausages!” Dorgan was said to have sketched a cartoon of Stevens pitching a sandwich with a dachs-hund. It had the caption: Get your hot dogs! But no proof of this cartoon has ever materialized.

However, there is evidence that German immigrants sold ‘hot dogs’ from carts in the Bowery in the 1860s. And, after all, the Germans are known for their sausages.

Maybe the better question is how the hot dog bun was developed. One story features a vendor in the 1870s who pro-vided white gloves to customers who bought his sandwiches. When customers did not return the gloves, he appealed to a baker to make a roll suitable for the long dog.

Elder orphans -- aging people with no spouse or children -- are a rising population in the world.

Currently 19 percent of women ages 40 to 45 have no children. About 15 million people in the U.S. live alone, including 27 percent of the 65-plus population, accord-ing to US News.

What happens to elders who can no longer care for them-selves is usually guardianship, a legal process that puts decisions in the hands of a court-appointed guardian.

But there are some ways to age with company, if not with family.

- Elder apartment and senior living communities can help forge friendships and lifestyle support. These can be expensive, however.

- Home sharing is one alternative. Renting out a bed-room in your home can bring income, and possibly friendship. Some home sharing arrangements offer free rent in return for housekeeping or meal prepara-tion.

- Churches are responding to the need. In Charlotte, NC, Love Inc. helps congregations form teams of people to help with transportation, shopping, yard work, cleaning and meal preparation.

- In Los Angeles, a buddy program pairs third-graders with residents of a Jewish Home for the Aging.

- An Elder Orphans Facebook group helps people sup-port each other.

For all aging people, a plan for social and physical help is essential. Work to form a family of church or social contacts to stay involved.

Healthy lifestyle is important, with regular exercise and good nutrition.

Urban areas can provide more interaction and usually have services located closer to home than rural areas.

Page 5: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

How July 4th became America’s birthdayPagesMage0718

July 4, 2018 marks 242 years since the signing of the Declaration of Indepen-dence in 1776.

Before the Declaration, 13 colonies ex-isted under the rule of England’s King George III. There had been growing un-rest, particularly because the King levied taxes on the colonists, who had no polit-ical representation to the King or Parlia-ment. When unrest became open rebel-lion, King George sent in troops.

In 1774, the colonies sent delegates to Philadelphia for the First Continen-tal Congress. After trying to work out differences with England, the colonies formed the Second Continental Con-gress in May of 1776. The delegates de-termined that further negotiations with England were hopeless. On June 28, 1776, Thomas Jefferson presented the first draft of the Declaration of Indepen-dence to Congress.

On July 4, nine colonies voted in favor of the Declaration. Pennsylvania and South Carolina voted against it, Delaware was undecided, and New York abstained. But the Declaration was approved.

John Hancock, president of the Conti-nental Congress, was the first to sign the Declaration of Independence. It is said that he signed his name “with a great flourish” so “King George can read that without spectacles!”

By the 1800s, parades, picnics, and fire-works were firmly established as part of America’s Independence Day traditions.

Women are Better Represented in Heart Trials but Gaps Still ExistCardioSmart

Female participation has increased in some heart-related drug trials but continues to fall short in others.

We’ve made progress in closing the gender gap of clinical trials but still have a ways to go, based on a recent study of female participation in heart medication trials from 2005–2015.

Women have long been underrepresented in clinical trials, despite known gender differences in health. Much of what we know about diseases, treatments and out-comes is based on studies involving men. To address this issue, increasing research involving women has been an important goal over the past few decades.

To see how we’re doing, researchers analyzed the makeup of 36 recent studies that tested the safety and efficacy of cardiovascular medications. According to authors, these were pivotal trials involving common heart drugs that are now taken by mil-lions of individuals with or at risk for heart disease.

Studies were conducted between 2005 and 2015 and overseen by the U.S. Food and Drug Administration (FDA), which ensures the safety of medications and other products affecting public health.

According to findings, which were recently published in the Journal of the American College of Cardiology, women were well-represented in many of the heart trials.

Based on the proportion of women affected by each condition, women were well-represented in studies related to high blood pressure and an abnormal heart rhythm called atrial fibrillation. Women were even overrepresented in studies of pulmonary arterial hypertension—a type of high blood pressure that affects the lungs and the heart.

However, women were underrepresented in studies involving heart disease, heart at-tack and heart failure. This finding is particularly concerning, as these conditions are leading causes of death and disability in the United States.

Heart disease alone causes 1 in 4 U.S. deaths each year and is the leading cause of death in both men and women.

Still, experts are encouraged by recent findings. We’ve made significant progress in increasing female participation in heart trials, which has helped identify key gender differences for treatment. Among the 36 trials included in this study, four trials identified gender differences in drug safety or efficacy that are now listed on the drug labels.

We still have a ways to go in closing the gender gap. Authors hope findings bring light to this important issue and encourage increased participation by women in future cardiovascular research.

Page 6: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

Mended Hearts does not give medical advice. As always, consult your physician before making any changes in

medication, food supplements, diets or lifestyle.

If you would like to receive the Mended Hearts newsletterby email please send your email address to:

Angie Boles at [email protected].

MENDED HEARTS CHAPTER 127 COOKEVILLEOfficersPresident Blanche Smithers 931-526-4497Vice President Laura Jackson 931-858-2196Treasurer Carolyn Smith 931-537-3659Secretary Marsha Godsey 931-252-1406

Accredited Visitors1. Bob Freeman Every other Monday 931-537-98112. Joe Carter Every other Monday 931-260-48163. Blanche Smithers Every other Monday 931-526-4497 4. Glee Miller Every other Tuesday 931-261-21705. Richard Miller Every other Tuesday 931-261-21706. Charles Jackson Every other Tuesday 931-858-21967. Laura Jackson Every other Tuesday 931-858-21968. Dennis Guzlas Every other Wednesday 931-858-01009. Karen Guzlas Every other Wednesday 931-858-010010. Debbie Greene Every other Wednesday 931-372-051311. Jim Greene Every other Wednesday 931-372-0513 12. Mona Neal Every other Thursday 931-526-939813. Louise Davies Every other Thursday 931-252-008114. Tom Tomberlin Every other Thursday 931-526-753515. Dot Tomberlin Every other Thursday 931-526-753516. Jim Hughes Every other Friday 931-528-126717. Barbara Hughes Every other Friday 931-528-126718. Sheila Thomison Every other Friday 931-581-608919. Jimmie Loftis Every other Friday 931-432-588520. Linda Loftis Every other Friday 931-432-588521. Carl Wingfield Every other Saturday 931-268-334822. Lorna Wingfield Every other Saturday 931-268-3348 ACCREDITED SUBSTITUTES23. Ray Savage Substitute 931-761-433624. Billy McElhaney Substitute 931-651-1288

NEWS LETTER COMMITTEESherry Shockley, Editor email: [email protected] 931-537-3182Angie Boles Publisher / Designer 931-528-2541Charles Jackson Photographer 931-858-2196

CHAPLAINRay Savage 931-761-4336

ACCREDITED VISITORS CHAIRMANRichard Miller - Chairman 931-261-2170Glee Miller - Co-Chairman 931-261-2170

FUND RAISER CHAIRMENDot Tomberlin Bake Sale 931-526-7535Richard Miller Silent Auction 931-261-2170

AED PROGRAMCharles Jackson - Chairman 931-858-2196

TAXES AND ADDRESS LABEL COMMITTEEWendell & Amelia Kendrick 931-526-6650

JAMESTOWN SATELLITESharon Parris 931-397-5960

CARDIAC REHABDebbie Baker 931-783-2786

SUNSHINE CHAIRMANCarolyn Shanks 931-858-3021

MARKYOURCALENDAR

Calendar of EventsJune 14 Board of Directors meeting

June 17 Fathers Day

June 21 First day of summer

June 21 Mended Hearts monthly meeting

June 26 Putnam Health Council

June 26 Jamestown MH Meeting

Fathers Day Word Search PuzzleS O Y A D N U S N O R A F D D

O D D D O R G A N I Z E A D T

H E F P D I R G S T F U T A T

S O N O R A D O D D G H H E R

S S E D A E D L Y H R E E V G

O E T N T I S F T N A S R P I

N O N K E A N E E W N A S H F

S I E N N G R T N O D R I H T

E N E F O S O R E T F J E U N

I E T N H I N N E T A E V E N

T N E M P I U Q E S T R O P S

K T N H N J D I N E H T L E E

C N I T E N H R E R E O W N D

E F N T S A F K A E R B A T A

N H E R S B I R T C H D A Y D

BREAKFAST

LOVE

CARD

NECKTIES

DAD

NINETEEN TEN

DADDY

PHONE

DAUGHTERS

PRESENT

FATHER

SONORA DODD

GIFT

SONS

GOLF

SPORTS EQUIPMENT

GRANDFATHER

SUNDAY

JUNE

THIRD

Page 7: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

Mended Hearts May meeting. Susan Ashburn, CRMC Stroke Program Coordinator speaks about strokes at the Mended Hearts May meeting.

Mended Hearts May meeting. Speaker Susan Ashburn, CRMC Stroke Program Coordinator speaks about strokes.

Left to right are Susan Ashburn, CRMC Stroke Program Coordina-tor and Laura Jackson, Mended Hearts.

National Education and Training Conference 2018

Join us in San Antonioalong the Riverwalk!July 14 – 18, 2018

See Blanche if you are interested in attending.

Registration begins at 7:30 a.m.Walk begins at 8:00 a.m.

Meet in front of CRMC’s main lobby

Walking for as little as 30 minutes a day can improve your health.

UPCOMING SCHEDULE:Saturday, June 16 • Scott Reising, MD, FACC

Cardiologist - Tennessee Heart

Saturday, June 23 • Tom Little, MD, FACCCardiologist - Tennessee Heart

Saturday, June 30 • George Ivey, MDGeneral Surgery - TN Department of Health

In the event of rain, the walk will be canceled and resume the next Saturday.

Take a step toward a better healthier you!

Page 8: Heart NEWSLETTER NEWS · 2019. 6. 26. · NEWS “It’s great to be alive ... We rush through this life and don’t take time to enjoy the simple pleasures of life. Happy sum-mer

MH2050E 2014

National Office Phone: 888-HEART99 www.mendedhearts.org

MEMBER ENROLLMENT

Member Information (please print or type) Date

Name (Mr/Mrs/Ms) Chapter Member-At-Large

Address (line 1) Phone ( )

Address (line 2) Alt Phone ( )

City/State/Zip Retired: Yes No

Email address Occupation

Family member (must reside at same address; please name): Preferred Contact: Phone Email Mail(Mr/Mrs/Ms) Family Member Email May Mended Hearts staff or volunteers contact you regarding local chapter opportunities? Yes No

Medical Info/Demographics (Optional for Mended Hearts reporting purposes in aggregate only)

Name of Heart Patient Name of Caregiver Date of Surgery/Procedure Phone Type of Surgery/Procedure Alt Phone

Many chapter newsletters include surgery/procedure anniversaries of members. Please indicate here if you are agreeable to having your name published in this way. 

Yes No

Add my email to monthly national email updates?  Add my email to monthly national email updates? 

Yes No Yes No Patient signature Family member signature Optional info: Date of birth Please check below: Optional info: Date of birth Please check below: Race: Caucasian; Black; Asian; Am. Indian; Other Race: Caucasian; Black; Asian; Am. Indian; Other Gender: Male; Female Gender: Male; Female

National Membership Dues: Includes subscription to Heartbeat magazine and one insignia pin for an individual or two pins for a family membership (must reside in same household). Select type of membership and include chapter dues (unless you wish to become a member-at-large). National dues are tax deductible less $10.00; Chapter and Lifetime dues are 100% tax deductible.

United States national member-at-large dues Chapter dues (please customize) Individual $20.00 Individual $ Family $30.00 Family $ Life – Individual Dues $150.00 Life – Individual Dues (if applicable) $ Life – Family Dues $210.00 Life – Family Dues (if applicable) $

Dues Summary: National dues $ I am joining as a non-heart patient: Physician RN

Chapter dues $ Health Admin Other Interested Party Other

TOTAL $ I would like to make a tax-deductible contribution of $

Please send payment with enrollment form to MHI chapter Treasurer. For member-at-large, send to:The Mended Hearts, Inc.National Office, 8150 N. Central Expressway, M2248 Dallas, TX 75206

Angioplasty Heart attack Diabetes Check here if also Heart Patient Atrial Septal Defect Pacemaker Valve-Surgery Procedure- specify: Aneurysm Transplant Valve Transcath CABG (Bypass) AFib arrhythmia ICD (Defibrillator) Stent Other arrhythmia Other

Donation to national $

Donation to chapter $ To chapter # Chapter Name: City, State______

Carolyn Smith588 Old Qualls RoadCookeville, TN 38506


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