Liver Disease Risk Assessment Form

Comprehensive Liver Disease Risk Assessment Made Simple

Early detection of liver disease can be life-changing. Whether you're concerned about liver health, managing known risk factors, or simply being proactive about your wellbeing, this liver disease risk assessment form provides a thorough, compassionate screening tool that helps healthcare providers identify potential concerns and connect patients with the right care.

Designed for hepatology clinics, primary care practices, gastroenterology centers, and integrated health systems, this template streamlines the entire liver health screening process—from initial risk assessment through hepatitis exposure evaluation to symptom documentation and consultation scheduling—all in one professional, easy-to-complete form.

Why healthcare providers choose this liver assessment template

Comprehensive screening in one place
Rather than juggling multiple intake forms, patient questionnaires, and scheduling systems, this template combines alcohol use screening (using validated AUDIT-C questions), hepatitis exposure history, cirrhosis symptom assessment, and direct appointment booking into a single, streamlined experience. Patients can complete everything at home before their visit, giving your clinical team a complete picture before the consultation even begins.

Evidence-based risk stratification
The form incorporates clinically validated screening tools and follows best-practice guidelines for liver disease assessment. Questions are structured to identify the most significant risk factors—from heavy alcohol consumption and viral hepatitis exposure to metabolic syndrome and family history—helping providers quickly stratify patients and prioritize those needing urgent intervention.

Patient-friendly without sacrificing clinical detail
Medical forms can feel intimidating, especially when addressing sensitive topics like alcohol use or past exposures. This template uses clear, non-judgmental language while still capturing the clinical specificity your team needs. Conditional logic ensures patients only see questions relevant to their situation, making the form feel shorter and more personalized.

Seamless appointment scheduling
Rather than creating a separate step, the form includes integrated scheduling fields that let patients book their hepatology consultation directly. Connect this to your calendar system via Stepper (stepper.io) workflows, and confirmations, reminders, and pre-appointment instructions can flow automatically—reducing no-shows and administrative back-and-forth.

How Paperform transforms liver health screening

This isn't just a static questionnaire. Paperform's flexible platform means this liver assessment form becomes a powerful tool for patient engagement, clinical workflow, and data insights:

• Conditional logic for smarter screening: If a patient indicates heavy alcohol use, additional AUDIT questions appear. Report hepatitis exposure, and you'll see targeted questions about vaccination status and viral load history. This intelligent branching keeps the form concise while ensuring nothing important gets missed.

• Automatic risk scoring and routing: Use Paperform's calculation engine to score responses and route high-risk patients immediately. Send urgent cases straight to your hepatology team via Slack or email, while lower-risk screenings flow into routine follow-up queues.

• Integration with your health IT ecosystem: Connect form submissions to your EHR, patient management system, or CRM using Stepper workflows, Zapier, or webhooks. Patient data flows directly into Epic, Cerner, Athenahealth, or whatever system you use—no manual data entry, no transcription errors.

• HIPAA-conscious design: While Paperform itself is not a HIPAA-compliant solution, this template is designed with privacy best practices in mind. Use it for pre-screening and appointment coordination, then transfer protected health information to your HIPAA-compliant systems using secure integrations.

• AI-powered insights for population health: With Paperform's AI Insights feature, you can analyze trends across all submissions—spotting patterns in alcohol consumption, hepatitis risk factors, or symptom clusters that inform public health initiatives, patient education programs, or preventive care strategies.

Perfect for hepatology clinics, primary care, and integrated health systems

This liver disease risk assessment template works beautifully across care settings:

• Hepatology and gastroenterology practices use it as a pre-consultation screening tool, helping specialists prepare for appointments with a complete risk profile and targeted questions ready to go.

• Primary care physicians leverage it for routine wellness checks and annual physicals, identifying patients who need specialist referral before liver disease progresses.

• Occupational health programs deploy it for workplace wellness screenings, particularly in industries with higher alcohol use or chemical exposure risks.

• Community health centers offer it as part of outreach programs targeting high-risk populations—connecting vulnerable patients to hepatology care they might not otherwise access.

• Telehealth providers use the form to efficiently screen remote patients, triaging who needs in-person evaluation versus virtual consultation.

Extend your liver care workflow with Stepper and Papersign

Once a patient submits their assessment, the real work begins—and that's where Paperform's companion tools shine:

Stepper workflows for care coordination
When a high-risk assessment comes through, Stepper (stepper.io) can automatically create a patient record in your CRM, send an urgent alert to your hepatology team, schedule a priority consultation, order baseline lab work, and send the patient a welcome email with pre-appointment instructions—all without touching a spreadsheet or sending a single manual email.

Papersign for consent and treatment plans
After the initial consultation, use Papersign (papersign.com) to send treatment consent forms, medication adherence agreements, or cirrhosis management plans for secure electronic signature. Everything stays connected to the original assessment for a complete, auditable patient journey.

Built for the way modern healthcare teams actually work

Healthcare providers don't need another complicated software platform that requires IT support and weeks of training. Paperform's doc-style editor means your office manager or clinical coordinator can customize this template in minutes—adjusting questions, adding your practice logo and branding, tweaking conditional logic, or connecting it to your scheduling system—no developers required.

And because Paperform is SOC 2 Type II compliant with enterprise-grade security, you can trust it as part of your patient engagement toolkit, even as your practice grows.

Get started with liver disease screening that works

Whether you're a solo hepatologist building a specialty practice, a multi-site gastroenterology group standardizing intake processes, or a health system launching a liver disease prevention program, this template gives you a professional starting point that you can deploy today and refine as your needs evolve.

With Paperform, you're not just collecting data—you're creating a seamless, compassionate experience that helps patients understand their liver health risks and connects them to the care they need, all while making your clinical team's job easier. Start screening smarter, not harder.