The code block below illustrates how one might use # and // as comments in your logic and calculations.

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rNK2EZXfJgD4o7GBM56UUG4Bfri6VxrajRaixsQH5IR6BvwuFS7wakBkiscIFhJhtYq7M3259Vu4sbIf7kS66xrAQMRuo8remMnMvPqQCPEaI9by

COVID-19 Outpatient Therapeutics - Patient Eligibility Intake Form

IMPORTANT UPDATES:

5/18/23 Update: Stanford Health Care will be transitioning to only reviewing requests for remdesivir infusions as treatment for COVID-19. There are several therapeutics that remain active against resistant subvariants and could be considered treatment options (e.g. Paxlovid, remdesivir, or molnupiravir). Please note, our COVID Outpatient Therapeutics team is only accepting remdesivir infusions requests. If you are interested in other treatment options, please direct patients to consult with their primary care provider, local pharmacy, or county health center to further discuss treatment options for COVID-19 treatment.

San Mateo: Coronavirus - San Mateo County Health (smchealth.org)
Santa Clara: Novel Coronavirus (COVID-19) - Public Health - County of Santa Clara (sccgov.org)

Thank you for understanding,

The SHC COVID-19 Outpatient Therapeutics Team

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 appointment 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 infusion therapy based on medication supply and clinical data available at the time of the referral.

For questions, please email DL-Stanford_Covid_Infusions@stanfordhealthcare.org.

Is the patient currently admitted to the hospital?

* must provide value

Yes

COVID-19 Outpatient Therapeutics - Patient Eligibility Intake Form

IMPORTANT UPDATES:

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