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Monoclonal Antibody Treatment Eligibility Screening Questionnaire Patient Name: Date of screen: Patient Date of Birth: Address:Phone number:Allergies Height: Weight Name of referring provider Phone

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How to fill out casirivimab and imdevimab are

01

To fill out casirivimab and imdevimab, follow these steps:

02

Check the vials for any visual defects or foreign particles. Do not use the vial if you notice any.

03

Use aseptic technique to withdraw 2.5 mL of casirivimab and imdevimab from each vial. Use a separate needle and syringe for each vial.

04

Combine the contents of both vials into one syringe. Ensure that the total volume is 5 mL.

05

The final concentration should be 200 mg/mL. If the concentration is higher or lower, do not use the solution.

06

Discard any unused portion of the solution.

07

Administer the solution within 6 hours of preparation.

08

Follow proper disposal guidelines for used needles and syringes.

Who needs casirivimab and imdevimab are?

01

Casirivimab and imdevimab are intended for individuals who are at high risk of progressing to severe COVID-19.

02

This includes people who are not fully vaccinated and have been exposed to someone with COVID-19 or are at high risk of exposure.

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It is also recommended for individuals who are not fully vaccinated and are at high risk of severe COVID-19, including those who are elderly or have certain medical conditions.

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What is casirivimab and imdevimab are?

Casirivimab and imdevimab are monoclonal antibodies used for the treatment of COVID-19.

Who is required to file casirivimab and imdevimab are?

Healthcare providers and facilities are required to administer and report the use of casirivimab and imdevimab.

How to fill out casirivimab and imdevimab are?

Casirivimab and imdevimab are administered intravenously following specific dosing instructions provided by the manufacturer.

What is the purpose of casirivimab and imdevimab are?

The purpose of casirivimab and imdevimab is to reduce the severity of symptoms and prevent hospitalization in patients with COVID-19.

What information must be reported on casirivimab and imdevimab are?

Providers must report patient demographics, treatment dates, dosing information, adverse reactions, and outcomes of treatment.

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