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Monoclonal Antibody Order Form Patient Name: Patient DOB: Patient Address: City: State: Patient Email: Zip Code: Patient Phone: Patient Allergies: Patient Diagnosis: COVID-19 19Date of Symptom Onset:
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How to fill out 19 monoclonal antibody treatment

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To fill out 19 monoclonal antibody treatment, follow these steps:
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Schedule an appointment with a healthcare provider who offers this treatment.
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Provide your medical history and disclose any allergies or medications you are currently taking.
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Discuss the potential benefits and risks of 19 monoclonal antibody treatment with your healthcare provider.
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If deemed eligible, sign consent forms and complete any required paperwork.
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Follow the instructions provided by your healthcare provider for receiving the treatment.
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Attend all scheduled appointments and adhere to the treatment plan recommended by your healthcare provider.
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Report any side effects or changes in your health to your healthcare provider.
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Follow up with your healthcare provider after the treatment for any necessary evaluations or additional care.

Who needs 19 monoclonal antibody treatment?

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19 monoclonal antibody treatment is typically recommended for individuals who meet certain criteria, such as:
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- Recently tested positive for a specific infection or condition, for which the monoclonal antibody treatment has been approved.
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- Are at high risk of developing severe symptoms or complications from the infection or condition.
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- Have a weakened immune system and may not mount an effective immune response on their own.
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- Have not received a previous monoclonal antibody treatment for the same infection or condition.
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- Have been referred by their healthcare provider for this specific treatment.

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