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Cardiac Risk Assessment Form

Asks about date of assessment, blood pressure (Both arms), and lipid panel values. Built for primary care ASCVD risk stratification and shared decision-making for statin initiation.

Questions
16
Pages
2
Time
about 4 min

Includes

  • E-signature
  • File upload
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Your practice

Cardiac Risk Assessment Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Primary care ASCVD risk stratification and shared decision-making for statin initiation
  • Cardiology consultation with comprehensive cardiac symptom and risk factor evaluation
  • Preventive medicine cardiovascular screening program documentation
  • Pre-surgical cardiac risk clearance using revised cardiac risk index (RCRI) criteria

What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Full NameText · Required
  2. Date of AssessmentDate
  3. Blood Pressure (Both Arms)Text
  4. Lipid Panel ValuesText
  5. Diabetes StatusLong Text

Page 2 · Additional details

  1. ASCVD 10-Year Risk ScoreNumber
  2. Chest Pain CharacteristicsLong Text
  3. NYHA Functional ClassLong Text
  4. Cardiac Examination FindingsLong Text
  5. ECG/Lab Results UploadFile Upload

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Cardiac Risk Assessment Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 16 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Cardiac Risk Assessment Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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