Living Kidney Donor Questionnaire
What a living kidney donor questionnaire asks, with sample questions on the recipient, health history, and support.
The living kidney donor questionnaire on this page records a potential donor's details, the intended recipient, medical and family history, and social history before a donor evaluation. The questions come from the Stony Brook Medicine living donor medical history questionnaire.
Living kidney donor questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a living kidney donor 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 living kidney donor questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What is your primary language?Personal details
- Do you need a translator?Personal details
- What is the recipient's name?Recipient
- How are you related to the recipient?Recipient
- Which medicines and supplements do you take?Medical history
- Which surgeries have you had, and when?Medical history
- Has anyone in your family had kidney disease?Family history
- Are your mother and father living?Family history
- Do you use tobacco, and for how long?Social history
- Do you drink alcohol, and how often?Social history
- Who is your emergency contact?Support
- Do you have support to help after surgery?Support
These are examples to read, not a form to fill in.
Living kidney donor questionnaire: FAQ
What does a living kidney donor questionnaire ask?
The sample questions on this page are based on the Stony Brook Medicine Living Donor Medical History and Behavioral Risk Assessment Questionnaire. This page groups them into six areas: personal details, recipient, medical history, family history, social history, and support.
Who fills in a living kidney donor questionnaire?
The person thinking about donating a kidney, not the recipient. The Stony Brook form is signed by the donor and by the coordinator or social worker who reviews it.
Does it ask about the recipient?
Yes. It asks for the recipient's name and how the donor is related to them.
Does it ask about family history?
Yes. The Stony Brook form asks about kidney disease, kidney cancer, heart attack or stroke, and other conditions in the family, and whether each parent is living.
Is there a living kidney donor questionnaire template?
The sample questions on this page show a typical set, based on one transplant program's form.
What happens after the questionnaire is completed?
The transplant team reviews the answers as part of the donor evaluation. AI Doctor only collects them; it does not decide who can donate.
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.
