Capsule Endoscopy Questionnaire
What a capsule endoscopy questionnaire asks, with sample questions on medicines, swallowing, bowel history, and devices.
A capsule endoscopy questionnaire records medicines, swallowing problems, bowel history, implanted devices, and other health details the care team checks before the camera capsule test. The questions on this page follow a gastroenterology practice's pre-capsule endoscopy questionnaire and the UCLA Health test preparation sheet.
Capsule endoscopy questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a capsule endoscopy 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 capsule endoscopy questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Which medicines do you take now?Medicines
- Do you take a GLP-1 medicine?Medicines
- Do you have difficulty swallowing?Digestion
- Have you been told your stomach empties slowly?Digestion
- Have you ever had a bowel obstruction?Bowel history
- Have you had small bowel surgery?Bowel history
- Do you have diabetes?Health conditions
- Could you be pregnant?Health conditions
- Do you have a pacemaker or defibrillator?Devices
- Do you have any other implanted device?Devices
- What is your height and weight?Measurements
- What is your waist size?Measurements
These are examples to read, not a form to fill in.
Capsule endoscopy questionnaire: FAQ
What does a capsule endoscopy questionnaire ask?
The sample questions on this page are based on a gastroenterology practice's pre-capsule endoscopy questionnaire and the UCLA Health capsule endoscopy preparation sheet. This page groups them into six areas: medicines, digestion, bowel history, health conditions, devices, and measurements.
Who fills in a capsule endoscopy questionnaire, and when?
The patient, before the test date. On the gastroenterology practice's form, both the patient and a staff member sign it.
Does it ask about bowel obstruction and pregnancy?
Both appear on the practice form, and UCLA Health's preparation sheet asks patients to tell the scheduling team if either applies. The care team decides what the answers mean for the test.
Does it ask about allergies?
Yes. The practice form opens with allergies and current medicines.
Is there a capsule endoscopy questionnaire template?
The sample questions on this page show a typical set. Preparation and medicine instructions come from the practice and are not part of this page.
What happens after the form is completed?
The practice's team reviews the answers before the test day. AI Doctor only collects them; it does not give preparation or medicine instructions.
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.
