Inpatient requests for EUA casirivimab and imdevimab should be initiated in Epic. Do NOT submit this form for hospitalized patients or compassionate use requests.

Do not leave anything blank. To ensure clinical eligibility, available drug supply, and bed capacity, our current process requires that all requests be reviewed and approved by a clinical team member. Upon receipt of the pertinent clinical information, you will receive a response via email within 24-48 hours about approval status and possible next steps.

SHC reserves the right to select the monoclonal antibody for infusion based on medication supply and clinical data available at the time of the referral. The general Fact Sheet for Patients, Parents, and Caregivers compiled by SHC from the FDA Fact Sheets is available in English Spanish, Vietnamese, Portuguese, Tongan, Samoan, Simplified Chinese, and Traditional Chinese.

For questions, please email dl-shc-pharmacy-covid@stanfordhealthcare.org.

Loading... Loading...
You have selected an option that triggers this survey to end right now.
To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.