Monoclonal Antibody Therapy Toolkit

For Bebtelovimab, please fax consent, order, monoclonal intake form, a copy of the (+) test and an office note to (518) 926-6286. PLEASE NOTE:  it is no longer necessary to page the COVID-19 pharmacist for approval

TREATMENT (Bebtelovimab)

PROPHYLAXIS (Evusheld)

Consent

Informed Consent

Consent

Evusheld Patient Consent

Drug Order Form

Physiciain Order Form

Drug Order Form

Evusheld Physician Order Form

Intake

Monoclonal Therapy Intake Form

Patient Fact Sheet

Evusheld Patient Fact Sheet

Patient Fact Sheet

Monoclonal Antibody Fact Sheet 

Provider Fact Sheet

Evusheld Provider Fact Sheet

Provider Fact Sheet

Provider Fact Sheet

Intake

Evusheld Intake Form

MD Communication

Provider Scripting for Monoclonal Antibody Treatment for COVID 19

 

 

Other COVID-19 Therapeutics – UNDER CONSTRUCTION

Glens Falls Hospital

100 Park Street
Glens Falls, NY 12801

Phone: 518-926-1000