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Prescriber name NPI Contact Fax Email If shipping to prescriber First Fill Always Never Clinical Information Please fax pertinent clinical and lab information Diagnosis B18. 2 Chronic Hepatitis C Virus Diagnosis date Genotype 1 2 3 4 5 6 Subtype A B A/B N/A Baseline viral load Date Degree of fibrosis F0 F1 F2 F3 F4 Cirrhosis None Compensated Decompensated CTP B C Co-infection s None HIV HBV Prior Regimen Na ve Experienced List below Start Date Transplant status N/A Pre-transplant...
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How to fill out hepatitis c virus

01
Obtain a hepatitis C virus (HCV) screening test from a healthcare provider.
02
Follow the instructions provided by the healthcare provider for collecting the blood sample for the test.
03
Submit the blood sample for testing at a laboratory or clinic.
04
Wait for the test results to come back.
05
If the test is positive for HCV, consult with a healthcare provider for further guidance and treatment options.
06
Adhere to the prescribed treatment plan and medication regimen as recommended by the healthcare provider.
07
Attend regular follow-up appointments to monitor the progress and effectiveness of the treatment.
08
Take necessary precautions to prevent the transmission of HCV to others, such as avoiding sharing needles or personal hygiene items.
09
Educate yourself and others about the risks, prevention, and treatment of hepatitis C virus.
10
Maintain a healthy lifestyle with proper nutrition, exercise, and avoiding excessive alcohol consumption.

Who needs hepatitis c virus?

01
Individuals who have engaged in high-risk behaviors such as sharing needles or equipment for injecting drugs.
02
People who have received a blood transfusion or organ transplant before 1992.
03
Healthcare workers who have been exposed to blood or needle sticks from HCV-positive patients.
04
Individuals who were born to mothers infected with HCV.
05
People with HIV infection.
06
Individuals who have received tattoos or body piercings in unregulated settings with improper sterilization techniques.
07
People with abnormal liver function tests or liver diseases.
08
Individuals who have had multiple sexual partners, history of sexually transmitted infections, or engage in unprotected sex.
09
Those who have a history of incarceration and have shared needles or had unsafe tattoo practices within correctional facilities.
10
Anyone who is concerned about their risk of HCV exposure or suspects they may have been exposed.
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Hepatitis C virus is a bloodborne virus that can cause liver inflammation and lead to serious liver problems.
Healthcare providers and laboratories are required to report cases of hepatitis C virus to the appropriate health authorities.
Healthcare providers can fill out a report on hepatitis C virus by providing information about the patient's demographics, medical history, and laboratory test results.
The purpose of reporting hepatitis C virus is to track and monitor the spread of the virus, provide appropriate treatment to affected individuals, and prevent further transmission.
Information such as patient demographics, medical history, laboratory test results, and risk factors for hepatitis C infection must be reported on hepatitis C virus.
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