Cardio AI - Beta Testing Program Application

1️⃣ Facility Information

Facility Name *

Facility Type *

City *

State/Province *

Country *

Zip/Postal Code *

Geographic Setting *

Urban

Suburban

Rural

Total Licensed Beds *

Cardiology Patients per Month *

Minimum 500 patients/month required

Number of Cardiologists on Staff *

Minimum 5 cardiologists required

2️⃣ Technical Requirements

EHR System *

EHR Integration Capabilities *

HL7 v2.x Support

FHIR Support

RESTful API Access

PACS System *

Must be DICOM-compatible

DICOM Capabilities *

C-STORE (Image Transmission)

C-FIND (Query/Retrieve)

WADO (Web Access)

Internet Speed (Mbps) *

Minimum 100 Mbps required

Network Type *

IT Support Team Size *

Number of dedicated IT staff available for integration support

IT Infrastructure Readiness *

3️⃣ Clinical Team & Engagement

Champion Physician Requirement

A designated Champion Physician is required to serve as the clinical lead with a 10 hours/week commitment for the 16-week program.

Champion Physician Name *

Champion Title *

Champion Specialty *

Champion Email *

Champion Phone *

Years in Practice *

Number of Testing Physicians (3-5 minimum) *

Minimum 3-5 physicians who will actively use the platform

Support Staff Availability *

Commitment to Weekly Feedback Sessions *

Yes, we commit to weekly 30-minute check-ins

No, this is not feasible

4️⃣ Research & Data Participation

IRB Approval Capability *

Yes, we have an IRB

We can use external IRB

No IRB available

Data Sharing Agreement *

We agree to share de-identified clinical outcomes data

We're interested in co-authorship on validation papers

We're willing to be featured in case studies (with approval)

Expected Patient Volume for Beta *

5️⃣ Motivation & Program Goals

Why do you want to participate in this beta program? *

Primary Goals for Beta Testing *

Improve diagnostic accuracy

Optimize clinical workflow

Enhance patient outcomes

Better risk stratification with 5 CVD calculators

Implement 24/7 real-time IoMT patient monitoring

Deploy AI-powered PACS/DICOM imaging analysis

Reduce physician documentation time

Establish innovation leadership in AI cardiology

Current Challenges in Cardiovascular Care *

Previous Experience with AI/ML in Healthcare

6️⃣ Primary Contact Information

⚠️ Important

This contact will receive all communications regarding the application and beta program. This may be the same as the Champion Physician or a different administrative contact.

First Name *

Last Name *

Title/Position *

Email *

Phone *

Best Time to Contact

📝 Application Acknowledgment

I acknowledge that I have read and understand the Cardio AI Beta Testing Program requirements. I confirm that all information provided in this application is accurate and complete. I understand that our facility will be evaluated based on the selection criteria outlined in the program documentation, and that only 10 sites will be selected from all applicants. If selected, our facility commits to actively participating in the 16-week beta program with the time and resource commitments outlined. *

✅ What Happens Next?

1. Applications reviewed May 16-22, 2026
2. 20 Finalists selected for interviews
3. Virtual interviews May 23 - May 31, 2026
4. Final 10 sites announced June 5, 2026
5. Program kickoff June 10-15, 2026
6. Beta testing begins June 16, 2026

By submitting this application, you agree to be contacted by Cardio AI regarding your beta program application.

🏥 Beta Testing Program Application

📋 Application Instructions