Inherited Heart Condition Questionnaire
What an inherited heart condition questionnaire asks, with sample questions for cardiovascular genetics clinics.
An inherited heart condition questionnaire records heart disease, causes of death, and genetic test results across a patient's blood relatives before a cardiovascular genetics visit. It's also called a sudden cardiac death family history or a cardiomyopathy genetics intake.
Inherited heart condition questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an inherited heart condition questionnaire in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample inherited heart condition questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is your ancestry on your mother's side?Ancestry
- Did any relatives marry a blood relative?Ancestry
- Are your parents living, and how old are they?Parents
- Does either parent have heart disease?Parents
- Do any brothers or sisters have heart disease?Siblings
- Are any of your siblings half-siblings?Siblings
- Has an aunt or uncle had heart disease?Extended family
- Do any cousins have a heart condition?Extended family
- What type of heart disease does each relative have?Heart disease
- How old was each relative at diagnosis?Heart disease
- Has anyone in your family had genetic testing?Genetic testing
- Can you send a copy of their report?Genetic testing
These are examples to read, not a form to fill in.
Inherited heart condition questionnaire: FAQ
What does an inherited heart condition questionnaire ask?
The questions on this page follow family history forms from UCLA and Kaiser Permanente. They cover six areas: ancestry, parents, siblings, extended family, heart disease, and genetic testing.
Who fills in an inherited heart condition questionnaire?
The patient, before a cardiovascular genetics visit. The UCLA form suggests checking with relatives when unsure.
Why list relatives without heart disease?
Both forms ask for all blood relatives, including those without heart disease. The answers are reviewed with the patient at the appointment.
Is it the same as a cardiomyopathy genetics intake?
It covers cardiomyopathy and more. The Kaiser Permanente form lists cardiomyopathy, arrhythmia, aneurysm, sudden unexpected death, and fainting during exercise as heart disease to report.
What if a relative's age or cause of death is unknown?
The Kaiser Permanente form says to estimate an age or range and to write 'unknown' for the cause. It also says it's fine to leave gaps.
What happens after an inherited heart condition questionnaire is completed?
A genetic counselor or the cardiology team reviews it at the appointment. Any decision about genetic testing stays with the clinicians.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
