HCV Screening by Med Staff
The Patient has unknown HCV status - have your patient complete Steps 1-3 before referral to HRA.
- OR -
The Patient has a HCV diagnosis, confirmed by an HCV RNA PCR-quantitative (HCV RNA), skip to Step #3 and order the remaining lab tests before referral.
Referral Decision in 3-Steps or Less
Step #1
​- Complete the two screening forms by using the following link from a computer or a cell phone.
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Hepatitis C (HCV) Diagnosis and Treatment Questionnaire
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Risk Factors for Exposure to Hepatitis C (HCV) Questionnaire​
​​Links
​​Click on this link - SCREENING FORMS
​​​​Or, copy and paste the following URL - https://app.formdr.com/practice/Mzk2MTU=/form/ECSYCJL1tgKVZ6tNCC-cCnhXa23kGiNN
- OR -
QR code
QR code
(Instructions for the patient if they are not familiar with QR codes - act like you are taking a photo of the QR code with your phone and select the website address when it shows up on your phone's screen.)​​
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Not working? Watch the video below for additional instructions.
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I​f the two HCV screening questionnaires indicate no risk, then no referral is needed.
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If after completing the two HCV screening questionnaires, the indication is that they are at risk of having been exposed to HCV, then go to Step #2 below