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Monoclonal Antibody Infusion Screening and Order Form Eli Lilly BamlanivimabPatient Name (First and Last): Date of Birth (mm/dd/YYY):1. Positive COVID-19 test result (Swab or Respiratory Sample) (circle
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How to fill out monoclonal antibody infusion screening
How to fill out monoclonal antibody infusion screening
01
Contact your healthcare provider to see if you are eligible for monoclonjson antibody infusion screening.
02
Provide your medical history and any relevant information to the healthcare provider.
03
Schedule an appointment for the screening at a designated infusion center or healthcare facility.
04
Follow any pre-screening instructions given by the healthcare provider, such as fasting or avoiding certain medications.
Who needs monoclonal antibody infusion screening?
01
Individuals who have tested positive for COVID-19 and are at high risk for progression to severe disease.
02
People who are within the first 10 days of symptom onset and are over the age of 12.
03
Those with certain underlying medical conditions that may increase their risk of severe illness from COVID-19.
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What is monoclonal antibody infusion screening?
Monoclonal antibody infusion screening is a process used to assess a patient's eligibility for receiving monoclonal antibody therapy.
Who is required to file monoclonal antibody infusion screening?
Healthcare providers or facilities administering monoclonal antibody infusions are required to file the screening.
How to fill out monoclonal antibody infusion screening?
Monoclonal antibody infusion screening can be filled out by healthcare professionals following specific guidelines provided by health authorities.
What is the purpose of monoclonal antibody infusion screening?
The purpose of monoclonal antibody infusion screening is to ensure that patients receive appropriate treatment and to monitor for any potential side effects.
What information must be reported on monoclonal antibody infusion screening?
The screening may include information such as patient demographics, medical history, current symptoms, and any relevant lab results.
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