COVID-19 Outpatient Therapeutics - Patient Self-Referral Form |
IMPORTANT UPDATES:Statement regarding Omicron Subvariants 11/21/22 Update: The CDC has reported a rapid increase in the circulation of certain COVID-19 variants in the US that are known to be ineffective to several monoclonal antibody (mAb) therapies for the prevention and treatment of COVID-19. Stanford Health Care has been monitoring these variants of concern within our geographic region and has decided we will no longer offer:
At this time, we highly encourage you to stay updated with the latest COVID-19 boosters and take necessary precautions (e.g. masking in public indoor areas) to avoid exposure. If you develop COVID-19, please inform your healthcare provider and fill out the SHC treatment self-referral form below. There are several therapeutics (Paxlovid, remdesivir, molnupiravir) that are still active against these resistant subvariants and are available. A member of the COVID Outpatient Therapeutics team will contact you for the best options for COVID-19 treatment. Thank you for understanding. Thank you, The SHC COVID-19 Outpatient Therapeutics Team |
Instructions
Please complete this form to be screened for outpatient COVID-19 treatment. Refer to the eligibility requirements listed below. Stanford Health Care reserves the right to select the specific treatment based on medication supply and clinical information available at the time of the referral.
A team member will review your response and contact you via phone or email within 24-48 hours to request additional information, if necessary, and to discuss appropriateness of infusion.
For questions, please call (650) 391-8503 on Monday through Friday between 8:00 am PST and 4:30 pm PST. Any calls received after hours will be returned on the next business day.
Billing
COVID-19 Outpatient Therapeutics at SHC is considered a telemedicine service and may be billed to you or your insurance. Additionally, COVID-19 infusion treatments are no longer covered by the US Government and you may be liable for the total cost. Our Financial Counseling team can provide a Good Faith Estimate and payment options. They can be reached at 650-498-2900 option 2.