Hep C Treatment Visit

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)- US/CT INSERT RESULTS
Prior Studies - Bx INSERT RESULTS IF DONE


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.

The following items are present-
* Fatty Liver on U/S - NO

*Women of child bearing age - NO
* Healthcare worker - NO
* Hep B co-infection - NO
* Diabetes - NO
* HIV co-infection - NO

**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:

1)      F0-3: Mavyret x 8 Weeks, 3 tabs po daily with food.

2)      F4 w/ compensated cirrhosis (Child Pugh A): Mavyret x 12 weeks, 3 taps po daily with food.

 

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)

Labs and F/u appointments @ weeks 4, 8 weeks from start of regimen as well as 12 weeks post completion of therapy.
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 AFMC Case Manager Pool who will schedule apt.

Follow Up Visits and Labs:

Care manager will schedule f/u visits with prescribing physician as noted below at the start of treatment to ensure pt does not get lost to f/u. PCP will order the subsequent lab at each visit.

8 Week Regimen:

  • At week 4 of treatment: CBC, CMP, Viral Load
  • At week 5 of treatment: PCP Visit
  • At week 6 of treatment: Viral load only if no response at week 4
  • At week 8 of treatment: AST/ALT
  • At week 9 of treatment: PCP Visit
  • At week 20 of treatment: Viral load
  • At week 21: PCP Visit

12 Week Regimen:

  • At week 4 of treatment: CBC, CMP, Viral Load
  • At week 5 of treatment: PCP Visit
  • At week 6 of treatment: Viral load only if no response at week 4
  • At week 8 of treatment: AST/ALT
  • At week 9 of treatment: PCP Visit
  • At week 12 of treatment: Viral load
  • At week 13: PCP Visit
  • At week 24: Viral load
  • At week 25: PCP Visit

 

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