Kidney Transplant Evaluation Questionnaire
What a kidney transplant evaluation questionnaire asks, with sample questions on kidney history, dialysis, and support at home.
The kidney transplant evaluation questionnaire on this page records kidney disease, dialysis, past transplant care, heart and general health, and home support before a transplant evaluation. The questions come from new patient questionnaires used by the UCLA Kidney and Pancreas Transplant Program and University Medical Center of Southern Nevada.
Kidney transplant evaluation questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a kidney transplant evaluation 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 kidney transplant evaluation questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What caused your kidney disease?Kidney history
- Have you had a kidney biopsy?Kidney history
- Are you on dialysis now?Dialysis
- Which type of dialysis do you have?Dialysis
- Have you been evaluated for a transplant before?Transplant history
- Do you have a living donor?Transplant history
- Have you ever had a blood transfusion?Health history
- Have you been diagnosed with diabetes?Health history
- Do you see a cardiologist?Heart history
- Have you had a heart stent or bypass?Heart history
- Do you have reliable transportation?Home support
- Do you live alone?Home support
These are examples to read, not a form to fill in.
Kidney transplant evaluation questionnaire: FAQ
What does a kidney transplant evaluation questionnaire ask?
The sample questions on this page are based on new patient questionnaires from the UCLA Kidney and Pancreas Transplant Program and University Medical Center of Southern Nevada. This page groups them into six areas: kidney history, dialysis, transplant history, health history, heart history, and home support.
Who fills in a kidney transplant evaluation questionnaire?
The patient referred for a transplant evaluation. The University Medical Center of Southern Nevada form asks patients to complete every line and write N/A where a question does not apply.
Does it ask about other transplant centers?
Yes. Both forms ask whether the patient is already listed at another transplant center, and the UCLA form also asks about any earlier kidney transplant evaluation.
Does it ask about life at home?
Yes. The UCLA form asks whether the patient lives alone, has reliable transportation, and cares for themselves or has someone's help.
Is there a kidney transplant evaluation questionnaire template?
The sample questions on this page show a typical set, taken from the two transplant program forms named above.
What happens after the form is completed?
The transplant team reviews the answers as part of the evaluation. AI Doctor only collects them; it does not decide who can have a transplant.
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.
