Monoclonal Antibody Therapy Toolkit

EFFECTIVE TUESDAY, SEPTEMBER 22 2022 WE ARE NO LONGER PROVIDING BEBTELOVIMAB TREATMENT.

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