Get Patient Consent Form Hepatitis C - Wv Dhhr - Dhhr Wv

Filling out the Patient Consent Form for Hepatitis C is a crucial step in your treatment journey. This guide will provide clear instructions to help you complete the form accurately and confidently, ensuring you are fully informed and prepared.

Follow the steps to complete the Patient Consent Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name in the designated space to indicate that you, the patient, are providing consent.
3. Review the counseling topics listed. Check the box next to each topic you acknowledge having discussed with your healthcare provider. This includes information about avoiding alcohol and illicit drugs, preventing re-infection, and understanding the birth control requirements based on your gender.
4. If applicable, agree to the terms regarding your drug and alcohol abstinence by confirming that you have been free from such substances for the past six months.
5. Sign the form in the space marked ‘Patient Signature’ to confirm your consent and acknowledgment of the information provided.
6. Enter the date of signing where indicated. Make sure the date is accurate and reflects when you completed the form.
7. Once you have filled out all necessary sections, save your changes. You may also download, print, or share the form as required to provide it to your physician for inclusion with the Prior Authorization request for Hepatitis C treatment.

Complete your Patient Consent Form online today for a smoother treatment process.