venturafamilymed
Sep 8, 20213 min
HEP C Treatment Visit Dot Phrase. Please read in detail and delete what is not relevant. Do not just copy and paste.
--DELETE EVERYTHING ABOVE HERE--
Clinic Note and Treatment Plan
HPI -
No H/o Jaundice, GIB, Varices, Encephalopathy, SBP, or Ascites
Review of Systems -
The Patient relates the following as they may pertain to medication use -
No Fatigue, No Headache, No Nausea, No Diarrhea, No Insomnia, No Irritability, No Depression, No Myalgia, No Dizzy episodes
Additionally, as noted in HPI plus -
CONSTITUTIONAL - NO weight changes, NO fever
CARDIOVASCULAR - NO chest pain, NO palpitations
RESPIRATORY - NO Cough, NO wheeze, NO SOB
GASTROINTESTINAL - NO Dysphagia, NO constipation, NO abdominal pain, NO hematochezia, NO melena, NO hematemesis
DERMATOLOGY - NO recent rash, NO pruritus, NO jaundice
ENDO/HEME/LYMPH -NO Edema
PSYCH/NEUROLOGY - NO current abuse of EtOH or drugs to the severity that would interfere with compliance.
PE -
GENERAL - A&O x4, NAD
HEENT - HNCAT, PERRLA without scleral icterus, neck supple without gland enlargement
HEART - RRR S1+S2, no murmurs, rubs, or gallops
LUNGS - CTA bilat, AEE bilat, no crackles, wheezes or rhonchi,
ABDOMEN - Soft, nontender, BS x4 NA, no organomegaly, no ascites, no r/g
EXTREMITIES - no edema, no clubbing
DERM - no jaundice, no spider angio, no caput medusa, no abnormal bruising, no ulcers
PSYCH - Appropriate mood and affect
LABS (INSERT RESULTS WITH DATES)
INSERT CREATNINE
.heplab
HIV (within the last 30 days)
AFP result (if cirrhotic)
Fibroscore result
Pregnancy test (this visit)
Insert Hep C genotype (and NS5A testing result when applicable)
Hepatitis A/B antibody results show immunity OR Prior Hepatitis Vaccinations completed or started - _
DIAGNOSTICS
Prior Imaging (within the last 6 months)- needed only if concerned for cirrhosis
Assessment/Plan
I have verified that patient meets inclusion criteria:
Prior Tx with a novel agent (IFN/Ribavirin are OKAY) - NO
Cirrhosis – YES OR NO
Decompensated (Child-Pugh B/C) = NO - no h/o Varices, Encephalitis, Ascites, Jaundice, or hospitalization for complications of liver disease
*If patient has decompensated cirrhosis, or h/o failed prior Tx using a novel agent, the patient will be referred to Hepatology Clinic.
This patient does not have HIV or Hep B co-infection.
**NOTE: If the patient also has HIV, these patients will be staffed and co-managed by Dr. Pawson. Please message Dr. Pawson.
GOLDCOAST: Hepatitis C All Genotypes
Based on the above classification the patient will undergo Treatment with the following:
Compensated Cirrhosis (Child Pugh A) or less: Mavyret x 8 weeks or Epclusa x 12 weeks
1) Medication reconciliation was performed as the above medication is known to interact with several medications including the following – Antiarrhythmics ( Digoxin), Pradaxa, Ethinyl estradiol- containing medications such as combined oral contraceptives, statins including Lovastatin, Atorvastatin, Simvastatin, Anti-Convulsants (carbamazapine), Antimycobacterials (rifampin), HIV Medications, or Herbal Supplements (St John’s Wort). Contraindicated: Amiodarone
Specific to sof/vel: Take sof/vel with food. Take PPI or fast acting antacids 4 hours after taking sof/vel. If on a H2B, take it the same time or 12 hours after taking sof/vel.
Labs and F/u appointments given to patient.
Instructions were given on the importance of not missing medication dosage, follow-ups and lab draws. All questions answered. The patient wishes to proceed with treatment and will be scheduled for a Nursing appointment for further information and instructions.
CVS caremark Rx filled out and forwarded to care manager. Next step will be f/u with care manager. Message sent to Jill Chen who will schedule apt.
Follow Up Visits and Labs:
Please order HCV Viral load 12 weeks after the patient's end date of medications.