| AUDIT-C/Marijuana Use Questionnaire |
Daklinza™ & Sovaldi® Agreement |
| Health Summary |
Daklinza™ & Sovaldi® Meds
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| Hep C Info- ASU |
Daklinza™ , Sovaldi® & Ribavirin Agreement
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| Hep C Info- Outside ASU |
Daklinza™ , Sovaldi® & Ribavirin Meds |
| Hepatitis C Treatment Recommendation Form |
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Epclusa® Agreement |
| Navigating Support Path |
Epclusa® Meds |
| Numbers Connection Test |
Epclusa® & Ribavirin Agreement |
| PHQ-9 |
Epclusa® & Ribavirin Meds |
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| Pre-Tx Insurance Screen |
Harvoni® Agreement |
| Pre-Tx Ltr - ASU |
Harvoni® Meds |
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Harvoni® & Ribavirin Agreement |
| End-Tx Letter - ASU |
Harvoni® & Ribavirin Meds |
| End-Tx Letter - Outside ASU |
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| SVR12 Cure Letter - ASU |
Olysio® & Sovaldi® Agreement |
| SVR12 Cure Letter - Outside ASU |
Olysio® & Sovaldi® Meds |
| SVR12 Letter - ASU |
Olysio®, Sovaldi® & Ribavirin Agreement |
| Yearly post treatment letter (ASU) |
Olysio®, Sovaldi® & Ribavirin Meds |
| Yearly post treatment letter- Outside ASU |
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Sovaldi® & Ribavirin Agreement |
| Symptoms Inventory |
Sovaldi® & Ribavirin Meds |
| Treatment Summary |
Sovaldi ®, Ribavirin, & Peginterferon Agreement |
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Sovaldi ®, Ribavirin, & Peginterferon Meds |
| Gilead Consent Genotype 1 Ledipasvir-Sofosbuvir |
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| Gilead Consent Genotypes 2,3 Sofosbuvir-Ribavirin |
Technivie™ & Ribavirin Agreement |
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Technivie™ & Ribavirin Meds |
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Viekira Pak™ or Viekira XR™ & Ribavirin Agreement |
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Viekira Pak™ or Viekira XR™ & Ribavirin Meds |
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Viekira Pak™ or Viekira XR™ Agreement |
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Viekira Pak™ or Viekira XR™ Meds |
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Zepatier™ Agreement |
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Zepatier™ Meds |
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Zepatier™ & Ribavirin Agreement |
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Zepatier™ & Ribavirin Meds |