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Monoclonal Antibody Therapy Toolkit

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

Informed Consent

Physiciain Order Form

Monoclonal Therapy Intake Form

Monoclonal Antibody Fact Sheet

Provider Scripting for Monoclonal Antibody Treatment for COVID 19

Other COVID-19 Therapeutics – UNDER CONSTRUCTION

100 Park Street
Glens Falls, NY 12801

Phone: 518-926-1000