Healthcare AI Application Evaluation
Please complete this form to evaluate the performance, safety, and usability of a healthcare AI application.
Evaluator Full Name
*
First Name
Last Name
Evaluator Email Address
*
example@example.com
Evaluator Role
*
Please Select
Clinician
Researcher
IT Specialist
Administrator
Other
Name of AI Application
*
Purpose of the AI Application
*
Assessment of Core Criteria
*
Rows
Poor
Fair
Good
Excellent
Accuracy of Results
1
2
3
4
User Interface & Usability
5
6
7
8
Integration with Existing Systems
9
10
11
12
Patient Safety
13
14
15
16
Data Privacy & Security
17
18
19
20
Clinical Relevance
21
22
23
24
How satisfied are you with the overall performance of the AI application?
*
1
2
3
4
5
What are the main strengths of this AI application?
What are the main weaknesses or limitations of this AI application?
Would you recommend this AI application for healthcare use?
*
Yes
No
Not Sure
Additional Comments or Suggestions
Submit Evaluation
Should be Empty: