Membership Application

CHAEN is an organization of physicians who treat and/or are interested in Hereditary Angioedema.

Do you treat patients with HAE, including Hereditary Angioedema and Acquired Angioedema due to C1 Inhibitor deficiency?

Or are you involved in research or other forms of care for HAE, including Hereditary Angioedema and Acquired Angioedema due to C1 Inhibitor deficiency?

If yes, then please join CHAEN. There are no membership dues and your participation would be greatly appreciated. Please complete and submit the application form!

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Name*

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Professional Designation

Please confirm the following:

1.*

I confirm that I am a Medical Doctor licensed in a Canadian jurisdiction to practice medicine

2.*

I confirm that I treat patients with HAE, including Hereditary Angioedema and Acquired Angioedema due to C1 Inhibitor deficiency and that I consent to have my name listed on the CHAEN Website as an HAE treating physician (Canadian physicians only)

I confirm that I am involved in research or other forms of care for HAE, including Hereditary Angioedema and Acquired Angioedema due to C1 Inhibitor deficiency

I confirm that I have read and am interested in furthering CHAEN’s Vision, Mission and Goals

Please see below a brief description of CHAEN’s Committees. If you are interested in participating, please indicate in the space provided.

Guidelines Committee

To update the Guidelines on the diagnosis, therapy and management of HAE at least every five years or whenever significant changes to therapy have occurred. Develop and implement a Knowledge Translation plan for the Guidelines.

Laboratory Committee

To ensure physicians have access to the most sensitive and specific assays for the diagnosis of HAE. To review the current state of assays for HAE available in Canada. To identify which laboratories perform reliable assays and make that information publicly available.

Registry Committee

To create an HAE Patient Register. To ensure as many HAE treating centres as possible are participating in the Patient Register.

Research Committee

To establish goals and a program to encourage HAE Research. To identify areas where there is a need for research in Canada. To encourage and assist in the development of research proposals. To promote participation in research by CHAEN members.

Committee of Interest:

Please outline relevant skill or experience:

Please provide the name of a member of CHAEN who can act as a reference. If you do not know any members, please indicate:*

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