Epidural Steroid Injection Pre-Procedure Questionnaire
What an epidural steroid injection pre-procedure questionnaire asks, with sample questions for pain clinic staff.
An epidural steroid injection pre-procedure questionnaire records spine imaging, blood thinners, allergies, health history, and the ride home before the injection visit. The sources are University of Wisconsin Hospital and Clinics, Northeastern Vermont Regional Hospital, and Campbell County Memorial Hospital sheets and forms, not a patient questionnaire.
Epidural steroid injection pre-procedure questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an epidural steroid injection pre-procedure 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 epidural steroid injection pre-procedure questionnaire questions
Questions built from hospital sheets and forms, written out so you can see the level of detail. Every practice words its own form differently.
- Have you had a spine MRI or CT?Spine history
- Have you had recent spine surgery?Spine history
- Do you take a blood thinner?Medicines
- Do you take aspirin or an NSAID?Medicines
- Are you allergic to x-ray contrast?Allergies
- Are you allergic to local anesthetics or latex?Allergies
- Do you have diabetes?Health history
- Do you have a bleeding disorder?Health history
- Are you taking an antibiotic right now?Current health
- Is there a chance you are pregnant?Current health
- Was your spine MRI or CT done elsewhere?Visit logistics
- Who will drive you home?Visit logistics
These are examples to read, not a form to fill in.
Epidural steroid injection pre-procedure questionnaire: FAQ
What does an epidural steroid injection pre-procedure questionnaire ask?
The sample questions on this page are based on University of Wisconsin Hospital and Clinics, Northeastern Vermont Regional Hospital, and Campbell County Memorial Hospital documents. None is a patient questionnaire, and this page groups them into six areas: spine history, medicines, allergies, health history, current health, and visit logistics.
Who fills in an epidural steroid injection pre-procedure questionnaire?
On the University of Wisconsin sheet, a screener records the answers and signs the form. With AI Doctor, the patient answers the same kind of questions in a conversation.
Does it ask about blood thinners?
Yes. The University of Wisconsin sheet has lines for anticoagulants, aspirin, and NSAIDs, and any instruction about them comes from the practice's clinicians.
Which allergies does it cover?
The Northeastern Vermont Regional Hospital sheet asks patients to report allergies, especially to local anesthetics, contrast dye, and latex. The University of Wisconsin sheet has a line for x-ray contrast.
Is there an epidural steroid injection pre-procedure questionnaire template?
The sample questions on this page show a typical set. AI Doctor asks the questions the practice sets for it.
What happens after the questionnaire is completed?
The practice's team reads the answers ahead of the injection. AI Doctor only collects them, and it never tells a patient to stop or continue a medicine.
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.
