Preoperative Cardiac Evaluation Form
What a preoperative cardiac evaluation form asks, with sample questions for surgical and cardiology teams.
A preoperative cardiac evaluation form such as Stony Brook's cardiac risk questionnaire records heart history, symptoms, past tests, risk factors, and blood thinners before surgery. It is used before planned surgery, and the answers can lead to a cardiology referral.
Preoperative cardiac evaluation form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a preoperative cardiac evaluation form 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 preoperative cardiac evaluation form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What surgery are you having?Surgery details
- Do you have a cardiologist?Surgery details
- Have you ever had a heart attack?Heart history
- Do you have a heart rhythm problem?Heart history
- Do you get chest pain with activity?Symptoms
- Do stairs make you short of breath?Symptoms
- Have you had a stress test, and when?Past tests
- Have you had an echo or a heart cath?Past tests
- Are you treated for high blood pressure?Risk factors
- Do you smoke, or did you smoke before?Risk factors
- Do you take any blood thinners?Blood thinners
- What dose do you take?Blood thinners
These are examples to read, not a form to fill in.
Preoperative cardiac evaluation form: FAQ
What does a preoperative cardiac evaluation form ask?
The questions on this page follow Stony Brook Medicine's cardiac risk screening questionnaire. They cover six areas: surgery details, heart history, symptoms, past tests, risk factors, and blood thinners.
Who fills in a preoperative cardiac evaluation form, and when?
The patient, before a planned surgery. At Stony Brook Medicine it is part of pre-admission screening.
Is it the same as a pre-surgical cardiology consult intake?
Not quite. The Stony Brook form is a screening step: depending on the answers, the patient may be asked to see a cardiologist before surgery.
Does a preoperative cardiac evaluation form clear a patient for surgery?
No. The surgical and cardiology team reads the answers and decides on any further tests or referral. Neither the form nor the avatar clears a patient.
How does the form record blood thinners?
The Stony Brook form asks for each blood thinner or antiplatelet medicine the patient takes, with the dose. The care team decides what to do with each medicine; the avatar gives no medicine advice.
What happens after the form is completed?
Staff review the answers against the planned procedure. On the Stony Brook form, an office-use box records whether a cardiology referral was made.
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.
