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Newly Diagnosed Hepatitis C Support Project
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Newly Diagnosed Hepatitis C Support Project
Alan Franciscus
Executive Director
Editor-in-Chief, HCSP
Publications
Author
Lucinda K. Porter, RNManaging Editor, Webmaster
C.D. Mazoff, PhD
Publication Design
Leslie Hoex, Blue Kangaroo Design
www.bluekangaroodesign.com
Reviewed by
Rose Christensen
Contact Information
Hepatitis C Support ProjectPO Box 427037
San Francisco, CA 94142-7037
alanfranciscus@hcvadvocate.org
This publication is supported by an
unrestricted educational grant from
Merck and Co.
The information in this guide is designed
to help you understand and manage
hepatitis C virus infection (HCV) and
is not intended as medical advice.All persons with HCV should consult
a licensed medical practitioner for
diagnosis and treatment of hepatitis C.
Version 3.0, 2011 2011 Hepatitis C Support Project
As I take my frst steps
with hepatitis C,
I am not alone because
o all those who will
help me along my journey
with their wisdom,
encouragement and hope.
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Table of CoNTeNTs1. Introduction Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. FAQs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3. Getting Organized . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
4. Choosing a Medical Provider . . . . . . . . . . . . . . . . . . . . . 7
5. Medical Provider Inormation . . . . . . . . . . . . . . . . . . . . . 9
6. Maximizing Your Medical Appointments. . . . . . . . . . . . . . . . 10
7. New Appointment Checklist . . . . . . . . . . . . . . . . . . . . . . 11
8. Your Medical History . . . . . . . . . . . . . . . . . . . . . . . . . . 16
9. Medication and Supplement History. . . . . . . . . . . . . . . . . . 17
10. Medication Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . 18
11. Tips or Lowering Prescription Drug Costs . . . . . . . . . . . . . . 20
12. Follow-up Appointment Checklist . . . . . . . . . . . . . . . . . . . 21
13. Medical Appointment Short Form . . . . . . . . . . . . . . . . . . 26
14. Calling Your Medical Provider . . . . . . . . . . . . . . . . . . . . . 27
15. More Tips about Medical Appointments . . . . . . . . . . . . . . . . 28
16. The Medical Alphabet . . . . . . . . . . . . . . . . . . . . . . . . . 29
17. HCV Laboratory and Diagnostic Tests. . . . . . . . . . . . . . . . . 31
18. HCV Lab Tracker. . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
19. Dos and Donts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
20. Tips or Living Well . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
21. Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
22. Notes Pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
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a letter t The Newy Digned with Heptiti C
Hello,
You recently ound out that you have hepatitis C. Beingdiagnosed with this brings up a lot o eelings and
questions about hepatitis C.
Some requently asked questions are:
WhatishepatitisCvirusinfection(HCV)?
Isitserious?WillIdie?
WillIneedalivertransplant?
IstheretreatmentforhepatitisC?
Cannaturalmedicinehelpme?
Isitcontagious?CanIgiveittomy familyandfriends?
HowdidIgetit?HowlonghaveIhadit?
DoesthismeanIamdisabled?
WheredoIgethelp,informationandsupport?
WhatdoIdonext?
Enclosed is inormation to help you nd answers to your
questions. This inormation is basic and assumes that you
have very little knowledge about hepatitis C. Hopeully it
reassures you. How can inormation about a disease be
reassuring?Webelievethatonceyougetthefacts,the
uture will look a little brighter.
In the beginning, you might be scared or angry. You might
eel hopeless or depressed. You might try to ignore the
situation, telling yoursel that this is not a big deal. These
reactions are normal. These eelings will not go away
overnight. This is part o the process o living with a disease.You are not alone. There are millions o people in the United
States and the world living with hepatitis C. What you dont
know yet is what some o us have learned over timethat
hepatitis C can teach you how to live better. Sure, all o us
would rather live without it. Treatment or hepatitis C is
eective or about one-hal o those who try it so someday
you may have the experience o living without it. However,
until that time comes, it is important to learn how to live
with hepatitis C.
You are embarking on a process that will teach you how
to make the best o a bad situation. Some people take
better care o themselves ater having this wake-up call.
They become healthier because they know that their lives
depend on it.
For now, lean on the rest o us who have aced this or along time. We probably have experienced some o what
you are going through and are more than willing to help.
You do not have to go through this alone. Enclosed is
inormation that will get you started.
lucindaK.Porter,R
N
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Here are some brie answers to some common questions.For more complete inormation, visit the Hepatitis C Support Projects website at
www.hcvadvocate.org
Wht is htitis C?Hepatitis C is a disease caused by the hepatitis C virus(HCV).Itprimarilyaffectstheliverandovertimecan
damage the liver and health o an individual. Usually ittakes a long time to do any damage, especially i the
person who has it doesnt drink alcohol and maintains ahealthy liestyle. Sometimes the damage is so minimal
that people will go through their entire lives withoutknowing they have HCV.
Is HCV rr?No. Approximately 3 to 4 million people in the United
States have HCV. Worldwide, more than 170 millionpeople have HCV.
How is htitis C digosd?
It is diagnosed with a blood test. The rst test most
people have is an HCV antibody test. I this is negative,it means you do not have hepatitis C, assuming you
have not been exposed in the past 6 months. I theresults are positive, then you need another blood test
called a viral load test. It is important that you have thissecond test because some people have a positive HCVantibody test but do not have HCV. Until you have this
test, you will not know or sure i you have HCV.
Is it srious?
Maybe. It should be regarded as a potentially seriousproblem. The good news is that or most people, HCV
will not create major health problems. Your medicalprovider will be able to determine the seriousness o
your particular situation.
Wi I di fro HCV?Most people will die with HCV and not o HCV. Out o
100 people who have hepatitis C, 3 or ewer will die anHCV-related death.
T WO
frequenty aked Quetin
Wht r th stos of htitis C?
Some people have little or no symptoms. This could
be because they hardly have any liver damage.Unortunately, it also could be because the liver is a
non-complaining organ. This means that there couldbe a lot o liver damage and hardly any symptoms.The most common symptom o HCV is atigue. Body
aches, fu-like symptoms, depression, and abdominaldiscomort are also symptoms o HCV. Since these are
symptoms o many medical conditions, it is important toseek medical help.
How do I kow if ivr is dgd?
The most accurate and reliable way to nd out is by
having a liver biopsy. Researchers are trying to developother ways to measure liver damage, but currently, liver
biopsy is the most reliable.
Dos hvig HCV I disbd?
No, it does not automatically mean you are disabled.The majority o those with HCV are able to work and
unction well. However, HCV aects everyone dierentlyand may interere with work and quality o lie.
Wi I d ivr trst?
This is very unlikely. The majority o people living with
HCV will not need a liver transplant.
Is thr trtt for htitis C?Yes, the medications to treat hepatitis C inection cancure it in about 50% o people who take them. Thesedrugs do have side eects. Talk to your medical
provider about whether treatment is right or you.
Continued
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If I dcid to udrgo trtt, wh shoud I strt?This depends on a number o actors. It is important tobe inormed about the treatment, what is involved, the
side eects and costs. Also, you need to evaluate thecurrent actors in your lie. Talk to your medical provider
about this. Treatment decisions do not need to be madeinstantly. I you need to delay treatment, ask your medical
providerifyoucandososafelyandforhowlong?
Is HCV trtt xsiv?Yes. However, many insurance plans cover most o thecost. See i you qualiy or a pharmaceutical patient
assistance program. For more inormation contactPartnership or Prescription Assistance www.pparx.org, or
Needy Meds www.needymeds.com, or the pharmaceuticalmanuacturer o the drug your doctor prescribes.
C tur dici h ?No herbs, supplements or alternative treatments havebeen proven to eectively treat HCV. Some herbs
may be harmul and even lethal. Some people haveexperienced health improvement rom acupressure,acupuncture, meditation, Tai Chi, Yoga and other
complementary health practices.
Is thr thig I c do to h ivr?Yes, there is a lot you can do. First, talk to your medical
provider. Avoid alcohol. Do not eat raw or undercookedshellsh. Get regular medical care. I you have never
had hepatitis A or B, be sure to get vaccines to protectyou rom these. Avoid or be cautious with potentially
liver toxic drugs, supplements, and chemicals. Tryto quit smoking and other tobacco use. Aim or thehealthiest liestyle you can manage, one that includes
regular exercise.
How did I gt it?HCV may be transmitted during activities that involveblood. In order to acquire HCV, a persons blood needs
to be in contact with HCV-inected blood. This canhappen in various ways. Some common ways are rom
blood transusions beore 1992 and sharing needlesor other injection drug utensils or works. There is an
occupational risk or those who have had a needle-stickinjury or mucosal exposure to HCV-positive blood. Thereis low risk o acquiring HCV sexually or or a mother
transmitting it it to her etus during pregnancy or delivery.There are other ways to acquire HCV and it is important
to obtain more inormation about this. It is normal towonder how you got hepatitis C. However, it can be
unhealthy to obsess about this. Try to ocus on what youcan do or yoursel now, rather than on the past.
How og hv I hd it?Your medical provider can help you determine this.Sometimes it is easy to answer this, but oten aneducated guess is made based on risk actors, medical
history and your current health inormation.
Is it contagious? Can I give it to my family and friends?Yes, it is contagious, but mostly only through blood. It isusually transmitted when people come in contact with
someones blood, such as by sharing contaminatedneedles, piercing and tattooing instruments and other
blood-related practices. I you do not share these withyour amily and riends, it is unlikely they will get HCV
rom you. We do recommend that you do not sharerazors, toothbrushes and other instruments that may haveyour blood on it. We do not know or sure that sharing
personal items is a risk, but it is better to be sae. Alwayscover any bleeding wounds or sores. It is not transmitted
by hugging, kissing, sneezing, coughing, sharing eatingutensils or glasses, or by casual contact. Although the
risks are low, it is recommended that amily members betested, especially children o women who may have had
HCV at the same time they were pregnant. You shouldnot donate blood or semen. Body organ and tissuedonation is made on a case-by-case basis. There is a
major shortage o donated organs, so sometimes an
HCV-positive organ is used or an HCV-positive recipient
Wht bout sx?The research is conusing about this sensitive,complicated and important subject. The Centers orDiseaseControl(CDC)doesnotrecommendany
changes in sexual practices between monogamous,long-term partners. Sexual transmission rates increase
with multiple sexual partners and risky sexual practiceswhere blood may be present. It is important to get
accurate inormation about sexual transmission o HCV.
Frequently Asked QuestionsContinued
a prm i chnc
r yu t d yur t. Duk eingtn
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Shoud I t sx rtr(s)?Yes. Although sex is a basic part o lie, many o us are
uncomortable talking about it. Honesty and openness areimportant. I your partner is uncomortable with the current
sexual practices in your relationship, it is his or her right to
express and change this. I you want to practice saer sex,it is your right to express and change this.
Wht shoud I t rtr, fi,or d co-workrs?Legally, you are not required to tell anyone. There areadvantages and disadvantages to telling others. For
more inormation about this, see: HCSPs Easy C Facts: Whom
Should I Tell? and Hep C Basics: Disclosure.
How do I tk to chidr bout this?It depends on their age and your assessment o your
childrens ability to handle this inormation. Sincechildren can sense when we have something onour minds, its a good idea to talk to them so theirimaginations dont make things worse than they might
already be. Try to nd something genuinely reassuringto tell them. Be brie but truthul. Ask them i they have
any questions. The CDC recommends that amilymembers be tested. Talk to your childrens doctor
about this. I your children are adults or old enough togive their assent, talk to them about testing. The mostimportant issue to discuss is prevention. Make sure
they know never to use your toothbrush, razor or cuticleclippers. Explain to them that they shouldnt share
anyones personal items.
Is thr vcci tht rotcts gist HCV?No, not at this time.
Wht do I do xt?Get accurate inormation and support. Avoid alcohol.Attend a support group. Try to make healthy choices.Find a medical provider who has a lot o experience
working with HCV patients and is someone you trust. Iyou have any reservations about your medical provider,
get a second opinion.
Whr do I gt h, ifortio d suort?
For more inormation about HCV rom HCSP, see:
Easy C: A Guide to Understanding Hepatitis C
Understanding HCV: A Patient Pocket Guide
HCSPsFactSheetSeries
The Hepatitis C Support Project lists support groups,
HCV specialists and has inormation about hepatitis C inmultiple languages. The website is www.hcvadvocate.org.
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This chapter will help you get your healthcare records in order by maintaining an allergy list,medication log, a health and medical history and emergency contact list.
Organizing your inormation helps you take charge o your own health.
T HR ee
Getting orgnized r the Heth It
Orgizig our hthcr rcords hs dvtgs. Ths r:
Allowsyoutouseyourtimemoreefciently
Willhelpyougetthemostoutofyourmedicalappointments
ReduceswheredidIputitfrustration
Maximizesyourabilitytonavigatethemedicalsystemeffectively
Ensuresthatatleastsomeonehasalltheinformation
Emphasizesthefactthatyouareinchargeofyourownhealth
How to OrganizeStart by asking or copies o your medical records.Although you have a right to copies, it is a common
legitimate practice to charge a ee or this. From now on,make it part o your routine to ask or copies o every
important piece o your medical records, especially testresults. The most recent copies are usually sucient.Important medical documents to have are:
HepatitisCviralload(HCVRNA)Genotype
Resultsfromliverfunctiontests,especiallyALTand AST values
Mostrecentcompletebloodcount(CBC)
Liverbiopsypathologyreport
Ultrasoundandimagingreports
HepatitisAandBimmunizationrecordsorlabresultsordates or those who have a history o either o these
Allrecentlabresultsthatscreenforotherdiseases or conditions
Here is a list o medical inormation that everyone should
maintain, young, old, healthy or living with a chronic disease:
AllergylistIncludemedications,foods,insects,latex, chemicals, etc.
Yourmedicalhistoryfromyourperspective (see Your Medical History)
Medicationlog (seeMedication and Supplement History sheet)
Alistofmajordiseasesinyourfamily
Noteswithdatesandpurposesofmajor
surgeries or other procedures
Ongoingjournalofmajormedicaleventsrom this day orward
Alistofcurrenthealthconcernsandquestions
Immunizationrecords
Contactinformationofallyourmedicalproviders (see Medical Provider Inormation sheet)
Emergencycontactinformation
HealthscreeningremindersandresultsHealthinsuranceinformation
Medicalcardormedicalidenticationnumber
AdvanceDirectives(Legaldocumentsstatingyourwishesforend-of-lifecareandyourdesignation o someone to advocate or these wishes. Althoughonly a small percentage o people with HCV will die rom it, AdvanceDirectives arerecommendedforeveryone.)
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Store everything in one place. Use whatever system
you preera notebook, le cabinet, computer or a box.The important goal is to make it a habit to keep all your
records in one place. I you store inormation on yourcomputer, make sure you keep a back up copy.
Keep all your appointment inormation in one calendar or
date book. You can also use this to record when you startor stop medications and other medical-related events.
Make it a habit to update your home medical records atereach medical visit or event. Do an annual review. Pick a
memorable date or this review, such as your birthday, NewYears Day, or the day ater you le your income taxes.
Home Health LibrarySome communities and hospitals have excellent reerencelibraries. Kaiser Permanente has many resources orits members. You can also start your own home health
library. You can save money by purchasing books atlibrary book sales, used bookstores, and garage sales,but check the copyright date to make sure the inormation
is current. See Resources or a more complete list. Here area ew suggestions:
Generalmedicalreferencebooks.Manyarewritten
or people without a medical background. The AmericanMedical Association, the Merck Manual, and major medicalcenters oer excellent reerence books or people
without a medical background.
Booksfocusingonhealthimprovement.The Owners Manual:
An Insiders Guide to the Body that Will Make you Healthier and Younger
by Roizen and Oz is a good one.
BooksabouthepatitisC.Therearemanygoodones.Livingwith Hepatitis C: A Survivors Guide, by Gregory Everson, andDr. Melissa Palmers Guide to Hepatitis and Liver Disease are
comprehensive and easy to understand.
T knw whr yu cn nd thing i th chi prt rning.
surc Unkwn
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Finding a new doctor or other medical proessional can take a
little eort. Doing some homework up ront can make your frst
appointment go more smoothly. Start by asking or a reerral.
I you are currently satisfed with one or more o your medical
providers, ask that source or a reerral. You can also ask
amily, riends and co-workers or suggestions. I you attend
a support group, that is another excellent resource. Next you
can check the providers background. Ater you have some
names, you can use the Internet to confrm that the provider
has a current license. The American Medical Association
(AMA),yourstatesmedicalboardandthecountymedical
association have inormation about physicians.
foU R
Ching Medic Prvider
This chapter will help you nd a new doctor or medical provider. You will learn how to check theirbackgrounds, ask the right questions and nd out what hospitals or medical clinics use physicians
in training. Doing some homework up ront can make your rst appointment go more smoothly.
www.ama-assn.org/aps/amahg.htmCan veriy a physicians credentials.
Also has tips on how to choose a doctor.
www.docboard.orgKeeps records o malpractice judgments or
some states and has links to other states.
www.docino.orgSearches or malpractice judgments or a ee per physician.
www.hcvadvocate.org
The Hepatitis C Support Projects physician database.
Note: Click on nd a physician button.
Clinics and hospitals that are aliated with medicalschools may use interns, residents and ellows as part
o their team. Interns are in their last year o medicalschool and have a good deal o medical training up to
that point. Residents are physicians who are training in aspecialty, such as internal medicine or gastroenterology.
Fellows are advancing their training in a specialized area
beyond residency, such as hepatology or oncology. Theadvantage to you is oten more time and attention during
your medical appointment. Many medical students andnew physicians have made a signicant impact on their
patients lives. There is also the satisaction o knowingyou are an important part o the medical education
process when you see someone during his or her training
Tip:Teaching hospitals and clinics rotate new
interns, residents, and ellows during the
monthsofJuly(andsometimesJanuary).Alwaysask
who will actually be perorming any procedures. I you
have the option to wait and it is medically sae to do so,
you may want to avoid complicated elective procedures
during July or January.
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Questions to Ask
Here are some questions to help you choose a medical provider. You
can ask these over the phone when talking to the oce sta, thus
saving precious ace-to-ace time.
Askiftheproviderisacceptingnewpatients.
Findouthowsoonyoucanbeseen.Whatisthe
typicalwaittimeforanappointment?
Isyourinsuranceaccepted?Ifso,becertainyou
understand any co-pays, deductibles, or otherout-o-pocket costs or which you may be responsible.
Doestheofcebillyourinsuranceorwillyouneedto pay the ee directly and manage the insurance
reimbursementyourself?
Ifyouareseeinganursepractitionerorphysician
assistant, then who is the physician overseeing his/herpractice?
Willyoubeseeinganintern,residentorfellow?
Whatarethefees?Doestheproviderchargefortimespenttalkingtoyouonthephone?
Willyoubeseeingtheprovideryouhavebeenassignedorwillyouseeotherpeopleinthatmedicalgroup?
Whichhospitalisthephysicianafliatedwith?
Doesthemedicalgrouphaveanadvicenursewhois
availableforphonecalls?
Ater you have met with the medical provider, take a moment to refect
on the appointment. Consider the ollowing:
Didtheproviderseemknowledgeable
andexperienced?
Doesthisprovidercommunicatewell?
Doyoufeeltheprovidergaveyouhisor herfullattention?
Isthisapersonyouwouldwantonyourmedicalteam?
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fI V e
Medic Prvider Inrmtin
Providers Name Phone Number Address
Primar CareProvider
Nurse(s)
Specialists
GI/Hepatolog
Nurse(s)
Other
Other
Pharmacist
Dentist
Other
NOTES
NOTES
NOTES
NOTES
NOTES
NOTES
NOTES
NOTES
NOTES
NOTES
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The time we spend talking to our doctors or other medical providers seems to be getting shorter.Here are some tips on how to maximize the time spent with your care provider.
1. Be prepared. Beore your appointment write down allo your medications, any pertinent allergies, a brie
medical history, and your chie health complaints.Include the names, addresses, and phone numberso your primary care provider and any specialists who
may be involved with your current medical issue.
2. You can prepare or your medical appointment byprioritizing and writing down your questions.
3. Maintain your own health records. It can expeditematters i you bring copies o your most recentpertinent medical reports.
4. Make eye contact beore speaking to your medical
provider. Once you begin speaking, your provider maytake notes. This does not mean s/he is not listening.
5. Beore you start with your list, ask how much time the
provider has or questions. Respect these limits andyou will benet in the long run.
6. Prioritize your health issues. Be brie but clear. Startwith the most important details and i there is time, you
can add the less important inormation at the end. Iyou have any ears or eelings, discuss them. It can be
reassuring to learn that your symptoms have nothing todo with some disease you have been dreading.
7. When describing your symptoms, begin with the
general picture and end with the specics. Example:My stomach hurts. I eel nauseous in the morning.
8. Ask or clarication. I your doctor uses words orexplanations you do not understand, ask her to clariy
or simpliy her words.
9. Take notes. I the doctor makes suggestions, write
them down. Ask him to spell any words you mightwant to reer to later, such as a diagnosis, medicationor procedure. I during the appointment you dont
have time to write everything down, write your notesimmediately ater while sitting in the lobby or your car.
10. Take a riend, especially or the complicated
appointments. Ask your companion to take notes oryou. I its all right with your provider, you can also recordthe appointment. Smartphones, iPhones, iPod touches
and similar devices have recording capabilities.
sIX
Mximizing Yur Medic appintment
This chapter discusses how to get the most out o your medical appointments. You pay or time
spent with your medical provider, so learning how to get the most out o it benets you.
11. I medication is prescribed, ask what the common sideeects are and how to take the medication.
12. Express your reservations. I your doctor suggests a
treatment plan that you have some concerns about,let her know. Sometimes these concerns can beeasily addressed.
13. Ask i there are any alternatives. I your doctor makesa treatment suggestion and it is not one that you are
prepared to ollow, ask about other options.
14. Keep an open mind. This can be your strongest
ally. It is amazing how many people will avoid amedication because o their ear o side eects, only
to nd out later that the reality was not anywherenear what they imagined.
15.Askthedoctor(orprovider)ifthereareresourcesor
support groups she would recommend.
16. Discuss the ollow-up plan. I diagnostic tests areordered, ask the provider when you can expect theresults and how these results will be conveyed to you.
Whendoesyourproviderwanttoseeyounext?Askifthere are any signs or symptoms that could be urgent
and need immediate reporting. I the results are goingto be disclosed at your next appointment, and i there
is going to be a long interval between appointments,ask how you can obtain earlier results. Additionally, askthe physician what the best way is to contact his oce
should a need arise that may not require an oce visit.
17. I this is a ollow-up appointment, ask or copies odiagnostic test results and surgical reports. This sets
a standard that you are the manager o your healthcare. It also makes it easier to give copies to other
health practitioners.
18. I you run out o time and still have more questionson your list, ask how you might be able to get the
answers to your questions without disrupting thephysicians schedule. Ask i you can leave a copy othe questions along with the request that they call you
back within a specied time rame.
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Complete part A o this orm and bring it with you when you see a medical provider or the rst time. I you can, bringcopies rather than your own copy o your records. Complete part B during or ater your medical appointment.
Bring the ollowing i you have them:
qYour advocate
qLaboratory test results
qLiverbiopsypathologyreport(s)
qHepatitis A & B immunization records or lab results(if available)forthosewhohaveahistoryofeitherofthese
q Allergy list Include medications, oods, insects,latex, chemicals, etc.
qYour medical history rom your perspective. Start with your _ currentmedicalproblems.(seeYour Medical History)
q Medication and Supplement Log (seeMedication and Supplement History)
q Liverultrasoundorimagingreport(s)
qA list o major diseases in your amily
qNotes with dates and purposes o hospitalizations,major surgeries or other procedures
qEmergency contact inormation
qContact inormation o all your medical providersqHealth insurance inormation
qMedical card or medical identication number
qAppointment book or calendar
qFor women date o last menstrual period
Whatisyourmainhealthconcern?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Whatquestionsorconcernsdoyouwanttocoverduringthisappointment?
List in order o importance, starting with the most important:_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Ifyouhavesymptoms,whatarethey?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Dothesesymptomsinterferewithanything,suchassleep,exercise,eating,orqualityoflife?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Ifyouareexperiencingpain,howmuchpainareyouhaving?Ratethisonapainscaleof1to10,with 1 being the least and 10 being the most pain.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Howlonghaveyouhadthesesymptoms?Whatmakesthemworse?Whatmakesthembetter?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
s e V e N
New appintment Checkit r HCV Ptient
It is highly recommended that you bring an advocate with you to your rst ew or any complicatedmedical appointments. This can be a riend, amily member or someone rom your support group.
PART A
NEW APPOINTMENT FORM SECTION
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MEDICAL PROVIDERS COMMENTS
Summary o visit: You or your advocate can complete this during or immediately ater your appointment.
Note: This is a very thorough orm. I your medical provider does not have time to answer all your questions, ask or the best way to get theseanswers.There may be someone else in the ofce that can help you. Some providers will call or email you later when they have more time.
Writedowninformationfromassessments,suchasbloodpressure_________________andweight_________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Whatisthenameforyourmedicalproblem(diagnosis)?_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Whatisthelikelycourse(prognosis)ofyourmedicalproblem?_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Arethereanysymptomsyoushouldwatchoutfororneedtocalltheproviderfor?_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Whatdoesyourmedicalproviderwanttodonext?
(If medication, treatment, surgery, or medical tests are ordered, see the next few pages.)_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
I you have any concerns or reasons why you might not be able to ollow the treatment recommendations, state them during the appointment.
Isthereanythingyoucandotohelpyourproblemorimproveyourhealth?_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Ifyourmedicalproviderwantsyoutoseeanotherspecialist,nurse,dietician,etc,whatisthenameandreason?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Wherecanyougetmoreinformationorsupportaboutthisproblem?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Doesyourmedicalproviderwantyoutoreturnforanappointment? q Yes q No Ifyes,when?
__________________________________________________________________________________________________________________________________________________________________________________________________________________
Othercommentsornotes:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
PART B
NEW APPOINTMENT FORM SECTION
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LABORATORY AND OTHER MEDICAL TESTS(Make multiple copies o this page in case your medical provider orders multiple lab tests)
If you have any concerns or reasons why you might not be able to have these recommended tests, state them during the appointment.
Doyouneedlaboratoryorotherdiagnostictests? qYes qNo
Ifyes,whenshouldyoucallorreturnfortestresults? ____________________________________________________________
I yes, complete the ollowing:
Nameoftest:_____________________________________________________________________________________________
Reasonforthetest: _______________________________________________________________________________________
_________________________________________________________________________________________________________
Whatisinvolved? _________________________________________________________________________________________
_________________________________________________________________________________________________________
Doyouneedtodoanythingprepareforit? qYes qNo _______________________________________________________
_________________________________________________________________________________________________________
Doesanythingaffecttheresults,suchasdrugs,alcohol,food,etc? qYes qNo _________________________________
_________________________________________________________________________________________________________
Arethereanyrisksordiscomfortinvolvedwiththistest? qYes qNo ___________________________________________
Whowilldoit?____________________________________________________________________________________________
_________________________________________________________________________________________________________
Wherewillitbedone? _____________________________________________________________________________________
_________________________________________________________________________________________________________
Howsoondoesitneedtobedone? ________________________________________________________________________
_________________________________________________________________________________________________________
Whenandhowdoyougettheresults? ______________________________________________________________________
_________________________________________________________________________________________________________
Wherecanyougetmoreinformationaboutthistest? __________________________________________________________
_________________________________________________________________________________________________________
Othercomments:_________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
NEW APPOINTMENT FORM SECTION
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MEDICATIONS AND TREATMENTS(Make multiple copies o this page in case your medical provider orders multiple medications or treatments)
If you have any concerns or reasons why you might not be able to follow the treatment recommendations, state them during the appointment.
Note: When you pick up your medications, read the label and make sure it states the same information your medical provider told you.
Doyouneedanymedicationortreatment?qYes qNo
I yes, complete the ollowing:
Name o medication or treatment: _____________________________________________________________________________
Isagenericformavailable?qYes qNo_______________________________________________________________________
Doestheproviderhaveanysamplesintheofceforyoutotrythemrst?qYes qNo
Reason or the medication or treatment: _______________________________________________________________________
Howmuchshouldyoutake? _________________________________________________________________________________
Howoftenshouldyoutakeit?________________________________________________________________________________
Whenshouldyoutakeit?____________________________________________________________________________________
Howlongwillyouneedtotakethismedicationfor? _____________________________________________________________
Willitinteractwithanyothermedicationsorsupplementsyouaretaking? qYes qNo ______________________________
___________________________________________________________________________________________________________
Shouldyoutakeitwithorwithoutfood? _______________________________________________________________________
Whatshouldyouavoidwhiletakingit,suchasalcohol,grapefruitjuice,drugs,certainfoods,oractivities?
___________________________________________________________________________________________________________
Whatarethepotentialbenets? ______________________________________________________________________________
Whatarethechancesitwillwork?____________________________________________________________________________
Arethereanymajorrisksandsideeffects? qYes qNo _________________________________________________________
Howcommonaretheserisksorsideeffects?___________________________________________________________________
Howsoonshouldyouexpecttoseeresults?___________________________________________________________________
Iftherearesideeffects,aretherewaystomanagethese? _______________________________________________________
Arethereanysideeffectsyoushouldreportorthatmaybepotentiallyurgent? qYes qNo _________________________
___________________________________________________________________________________________________________
Whatmighthappenifyouavoidedordelayedtakingthismedicationortreatment? _________________________________
Arethereotheroptions?qYes qNo _________________________________________________________________________
Wherecanyougetmoreinformationaboutthistreatment? ______________________________________________________
Other questions or comments:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
NEW APPOINTMENT FORM SECTION
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SURGICAL OR MEDICAL PROCEDURES
I you have any concerns or reasons why you might not be able to ollow the treatment recommendations, state them during the appointment.
Remember: It is your right to ask or a second opinion. It is oten a good idea to get a second opinioni the surgery is complicated, or i you have reservations about the procedure or surgeon.
Name o procedure _________________________________________________________________________________________Reason or the procedure ____________________________________________________________________________________
Whatisinvolvedwiththeprocedure? __________________________________________________________________________
Will you need any anesthesia qYes qNoifyes,whatkind?_________________________________________________
Whatarethepossiblebenetsoftheprocedure? _______________________________________________________________
Whatarethepossiblerisksorcomplications? __________________________________________________________________
Howcommonarethese?____________________________________________________________________________________
Whatarethechancesitwillwork?____________________________________________________________________________
Howsoonshouldtheproceduretakeplace?___________________________________________________________________
Arethereothereffectivebutlessinvasiveoptions? _____________________________________________________________Whatmighthappenifyouavoidordelaytheprocedure? ________________________________________________________
Whatdoyouneedtodotopreparefortheprocedure? __________________________________________________________
Name o person perorming the procedure: ____________________________________________________________________
Howmuchexperiencedoesthesurgeon/doctorhavewiththisprocedure? ________________________________________
Willaresidentbeworkingwiththesurgeonordoctor? qYes qNo ______________________________________________
Whowillactuallybeperformingtheprocedure? _________________________________________________________________
Wherewilltheprocedurebeperformed? _______________________________________________________________________
Howlongwilltheproceduretake? ____________________________________________________________________________
Howlongwillyouhavetostayaftertheprocedure? _____________________________________________________________Willyouneedsomeonetodriveyouandcareforyouaftertheprocedure? qYes qNo
Howlongistherecoveryperiod?_____________________________________________________________________________
Arethereanyrestrictionsaftertheprocedure? qYes qNo ______________________________________________________
Willyouhaveanydiscomfortaftertheprocedure? qYes qNo __________________________________________________
Howarepainandotherpost-procedureproblemstreated? ______________________________________________________
Ifabiopsyisinvolved,howandwhendoyougettheresults? ____________________________________________________
Wherecanyougetmoreinformationaboutthisprocedure? ______________________________________________________
Other questions or comments: _______________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________________
Tip:It is common practice to stop taking any medications that
reduce blood-clotting or a period o time prior to most
procedures, such as liver biopsies. These include aspirin, ibuproen,
naprosyn, and other common medications. Dietary supplements may
also reduce blood-clotting, such as vitamin E, licorice, dandelion, etc.
Report all supplement use to your medical provider.
NEW APPOINTMENT FORM SECTION
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e I G HT
Yur Medic Hitry
You can maximize your time by preparing or the appointment. Keeping a written record o your medicalhistory will help you use the time more eciently. Bring a copy o this with you to the appointment. You
can give your healthcare provider a copy or you can reer to it during the appointment.
Yourname,dateofbirth,andethnicorracialbackground.
Anyallergiestomedications,food,orothersubstances.
Alldietarysupplementsanddrugsthatyouaretaking
or have taken recently. Include prescription, over-the-counter, etc.
Ifyouarepregnantorbreastfeeding.
Childhoodillnessesandimmunizationsyouhave
had and when.
Anymajorillnessesyouhavebeendiagnosedwith,especially those that are still active or have been
diagnosed recently.
Anysurgeriesyouhavehad.
When you see a new healthcare proessional the appointment starts with communicating details
about your present and past medical history. The time to talk will probably be short, so use it well.
Lifestyle-Areyoumarried?Anychildren?Whatare
their ages?Whatisyouroccupation?Whatisyourbirthplace?
Describeyourdrinking,smoking,eatingandexercise habits.
Placesyoutraveledtorecentlywhereyoumayhave
been exposed to health risks.
Familyillnessesandcauseofdeathofcloserelatives.
Anyrecentlifechanges,suchasdivorce,jobchange,
death or illness o amily member or close riend.
Thenames,address,andphonenumbersofall.
healthcare providers and pertinent past providers.
Anyrecentdiagnosticresultsorothermedicalreports.
When listing your illnesses and surgeries, start with themost recent and work backwards. Your wisdom teethremoval when you were 15 years old is ar less important
than last years gall bladder surgery. A recent diagnosiso thyroid disease is more important to mention than the
bladder inection you had two years ago. The exception tothis is i you are being seen or a current bladder inection
and you get them requently.
Try to be honest. It takes time to build trust. However,medical proessionals who dont have all the inormation
cant make inormed recommendations. I a concerninfuences your ability to be truthul, state that. For
example, I dont want to tell you that I smoke tobaccobecause I dont want to be lectured about it. The truth is Ismoke, I know it is bad or me, and I am not ready to quit
at this time. I I need your help with this in the uture, I willbring it up. This is a clear message. It tells the healthcare
provider that you are a smoker, aware o the risks andrelieves you o the ear o a lecture.
Stay current. Review your medical history annually and
every time you have a change in your health. Pick anannual date or this review, such as around your birthdayor ater you le your income taxes. Keeping your medical
history up-to-date beore you have an urgent medicalneed will help you when you will need it the most.
What to include in a medical history
NEW APPOINTMENT FORM SECTION
I ik gd try w td.Tht i th rn I m m-tim rcd t t thm my-
. Mrk Twin
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N I N e
Medictin nd suppement Hitry
NEW APPOINTMENT FORM SECTION
Name
How MuchHow Often
How Long Reason
Prescribing
(Dose) Providers Name
Prescription
Medication
Non-prescription
Medication
Dietary
Supplements
RegulaR
OCCaSIOnal/aS neeDeD
ReCenTly STOppeD (paST mOnTH)
OTHeR
Medications Taken
in the Past Year
Recreational
Drugs
Prescription
Medication
Non-prescription
Medication
Dietary
Supplements
Prescription
Medication
Non-prescription
Medication
Dietary
Supplements
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T eN
Medictin Guideine
Know the ollowing about your medications
Genericandbrandnamesofmedication
Reasonyouaretakingthemedication
Thedoseofthemedication
Thefrequencyyoushouldtakethemedication
Thetimeofdayyoushouldbetakingyourmedication
Ifitwillinteractwithanyothermedicationsorsupplements you are taking
Ifyoushouldtakeitwithorwithoutfood
Ifyoushouldavoidanythingwhiletakingit,suchasalcohol, graperuit juice, drugs, certain oods or activities
Thelengthoftimeyouwillneedtotakethismedication
Ifyouneedtonishtheentireprescription
Thedrugsexpirationdate
This chapter discusses ways to manage your medications. Since this can be tricky,
particularly medications used or HCV treatment, spending a little time reading and askingquestions about your medications will help you take them saely and correctly.
Thestorageinstructionsforthemedication
Themajorrisksandsideeffects
Iftheserisksorsideeffectsarecommon
Iftherearesideeffects,waystomanagethese
Ifanysideeffectsshouldbereportedorthatmaybepotentially urgent
Howsoonyoushouldexpecttoseeresults
Whattodoifyouarelateormissadose
Howtorellthemedication
Howmanydaysbeforeyourunoutshouldyou
request a rell
Whatthismedicationwillcostyou
Wheretogetmoreinformationaboutthismedication
Guidelines or Managing Medications Saely
1. Ask your medical provider i there are ways you
can care or yoursel that may help you avoid orreduce the need or medications, surgery, or anyinvasive procedures.
2. Understand the correct instructions or taking your
medication. Make sure these exactly match theprescription label. I the two instructions are not
identical, clariy this beore taking the medication.
3. Know the medications side eects beore youstart taking it.
4. Beore taking a new medication, ask i there are anymedications or oods that should not be mixed with it.
5. Take the minimum eective prescribed dose unlessadvised otherwise.
6. Take medication with a ull glass o water unlessotherwise directed.
7. Ask i you are supposed to take all o your
prescription. For instance, always take the entireprescription o antibiotics even i you eel better.
8. Never break, crush, or dissolve a pill, tablet, or
capsule without making sure this is all right to do.Some medications need to be intact so stomach acidsdo not destroy them. I swallowing pills is dicult or
you, tell your medical provider.
9. Do not take medication in the dark or without yourglasses i you need them to read the label.
10. For liquid medications, use standard measuringspoons rather than eating utensils.
11. Try to take your medications on time. Find out what
you are supposed to do i you are late or miss a dose.
Never double up on a dose unless you are clearlyinstructed to do so.
12. I you have trouble remembering to take medication,
ask a pharmacist, nurse or other health provider ortips. Calendars, alarms, computer reminders, notes
and daily pill cases can provide reminders.
Continued
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13. Do not take a medication that has expired, smellsor looks odd to you. This is especially important orliquid medications.
14. I you pick up a prescription and the medication looks
dierent rom the last time you took it, talk to yourpharmacist to make sure there has not been an error.
15. I you did not take the medication as prescribed, tell
your medical provider.
16. Do not use someone elses medication or give yourmedication to anyone else.
17. Keep medications in their original container with a
secure cap.
18. I the cap is dicult to remove, ask your pharmacistor a dierent type.
19. Store medications as directed.
20. I you are traveling by air, carry medications with youin the cabin. Keep them in their original containers
with the prescription label.
Gs fr Maagg Mcas Safy Continued
21. Do not leave medications in a hot car.
22. Keep medications away rom childrens reach.23. I you are or may be pregnant, tell your provider this
beore you take any medication. Also, mention i you
are breasteeding.
24. I you are hospitalized or in a position where someone
else gives you your medication, look at what you aretaking beore you take it. I something does not lookright, ask or clarication or assurance.
25. I you think you are having an allergic reaction to a
medication, seek immediate medical help.
26. Formulate an emergency plan in case o accidentaloverdose or medical emergencies. In the United
States, 911 is the standard emergency phone number.I you use a cell phone, calls go to a central dispatch
location. This can cause delays. Near your phone,post the numbers o your local poison control center,police, re, physician, and hospital emergency room.
Poison Control Center: 1 (800) 222-1222
Th crt hth r thmind nd dy i nt t murnr th pt, wrry ut th u-
tur, r nticipt tru ut t
iv in th prnt mmnt wi-
y nd rnty. buddh
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e l e V e N
Tip r lwering Precriptin Drug Ct
Prescription drug costs are going up. Dont be embarrassed i you cant aord a medication. Nearly everyone hasbeen hit by rising healthcare prices. The ollowing are some cost-saving tips to consider:
This chapter suggests ways to lower your prescription drug costs with cost-saving tips, suchas purchasing wholesale or through reliable Internet-based pharmacies.
Askyourdoctorifthereisacheaperversionofyourmedication,suchasagenericform.
Inquireaboutfreesamples.
Shopforthebestdrugprice,suchasthroughCostco,wholesale,orreliableInternet-basedpharmacies.
Askifthereareanyclinicaltrialsinyourareausingthedrugtreatmentthatyouneed.
Lookfordiscounteddrugprices,suchasthroughyourinsuranceplan,orAARP.Insurancepharmacy
mail order plans can really cut costs.
Ifitsadrugyouarecondentyouwillbetakingforsometimeandatasteadydose,seeifa90-daysupply costs less than a 30-day supply.
Seeifyouqualifyforapharmaceuticalpatientassistanceprogram.Formoreinformationcontact
Partnership or Prescription Assistance www.pparx.org or Needy Meds www.needymeds.com
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Complete part A o this orm and bring it with you when you see a medical provider or the rst time. I you can, bring
copies rather than your own copy o your records. Complete part B during or ater your medical appointment.
Brg h fwg f y hav hm:
qYour advocate
qAny new test results that were ordered by anothermedical provider
qMedicationlog(seeMedication andSupplement History)
q Any new inormation or allergies to add to yourmedical records
q Medical card or medical identication number
qAppointment book or calendar
qFor women date o last menstrual period
Whatisyourmainhealthconcern? _________________________________________________________________________
_________________________________________________________________________________________________________
Whatquestionsorconcernsdoyouwanttocoverduringthisappointment? List in order o importance, starting with the
most important: ____________________________________________________________________________________________
Ifyouhaveanynewmedicalproblemsorsymptoms,whatarethey? ____________________________________________
_________________________________________________________________________________________________________
Dothesesymptomsinterferewithanything,suchassleep,exercise,eating? ______________________________________
_________________________________________________________________________________________________________
Ifyouareexperiencingpain,howmuchpainareyouhaving?Ratethisonapainscaleof1to10,with 1 being the least
and 10 being the most pain: _______________________________________________________________________________
_________________________________________________________________________________________________________
Howlonghaveyouhadthesesymptoms? ___________________________________________________________________
_________________________________________________________________________________________________________
Whatmakesthemworse?Whatmakesthembetter? __________________________________________________________
_________________________________________________________________________________________________________
Haveyouhadanychangesinyourlifethatmayhaveaffectedyourhealth,suchasdeathofalovedone,divorce,
insomniaorsubstanceuse?________________________________________________________________________________
_________________________________________________________________________________________________________
It is highly recommended that you bring an advocate with you to your rst ew or any complicated medical appointments.This can be a riend, amily member or someone rom your support group.
T WelV e
fw-Up appintment Checkit r HCV Ptient
This section suggests guidelines or how to maximize your ollow-up appointments with your
medical provider. Providing up-to-date inormation will help make your appointment go smoothly.
PART A
FOLLOW UP APPOINTMENT FORM SECTION
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MEDICAL PROVIDERS COMMENTSSummary of visit: You or your advocate can complete this during or immediately after your appointment.
Note: This is a very thorough orm. I your medical provider does not have time to answer all your questions, ask or the best way to get theseanswers.There may be someone else in the ofce who can help you. Some providers will call or email you later when they have more time.
Writedowninformationfromassessments,suchasbloodpressure_________________andweight_________________
_________________________________________________________________________________________________________
Ifyouhaveanewmedicalproblem,whatisthenameofyourmedicalproblem(diagnosis)? ________________________
_________________________________________________________________________________________________________
Whatisthelikelycourse(prognosis)ofyourmedicalproblem?__________________________________________________
_________________________________________________________________________________________________________
Arethereanysymptomsyoushouldwatchoutfororneedtocalltheproviderfor?_________________________________
_________________________________________________________________________________________________________
Istherenewinformationortreatmentaboutyourmedicalproblem? _____________________________________________
_________________________________________________________________________________________________________
Whatdoesyourmedicalproviderwanttodonext?
(If medication, treatment, surgery, or medical tests are ordered, see the next few pages.)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
I you have any concerns or reasons why you might not be able to ollow the treatment recommendations, state them during the appointment.
Isthereanythingyoucandotohelpyourproblemorimproveyourhealth? ________________________________________________________________________________________________________________________________________________
Ifyourmedicalproviderwantsyoutoseeanotherspecialist,nurse,dietician,etc,whatisthenameandreason?
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Wherecanyougetmoreinformationorsupportaboutthisproblem? ___________________________________________
_________________________________________________________________________________________________________
Doesyourmedicalproviderwantyoutoreturnforanappointment?q Yes q No
Ifyes,when? _____________________________________________________________________________________________
Othercommentsornotes:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
PART B
FOLLOW UP APPOINTMENT FORM SECTION
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LABORATORY AND OTHER MEDICAL TESTS(Make multiple copies o this page in case your medical provider orders multiple lab tests)
If you have any concerns or reasons why you might not be able to have these recommended tests, state them during the appointment.
Doyouneedlaboratoryorotherdiagnostictests? qYes qNo
Ifyes,whenshouldyoucallorreturnfortestresults? ____________________________________________________________
if ys, cm h fwg:
Nameoftest:_____________________________________________________________________________________________
Reasonforthetest: _______________________________________________________________________________________
_________________________________________________________________________________________________________
Whatisinvolved? _________________________________________________________________________________________
_________________________________________________________________________________________________________
Doyouneedtodoanythingprepareforit? qYes qNo ______________________________________________________
_________________________________________________________________________________________________________
Doesanythingaffecttheresults,suchasdrugs,alcohol,food,etc? qYes qNo _________________________________
_________________________________________________________________________________________________________
Arethereanyrisksordiscomfortinvolvedwiththistest? qYes qNo ___________________________________________
_________________________________________________________________________________________________________
Whowilldoit?____________________________________________________________________________________________
_________________________________________________________________________________________________________
Wherewillitbedone?_____________________________________________________________________________________
_________________________________________________________________________________________________________
Howsoondoesitneedtobedone? ________________________________________________________________________
_________________________________________________________________________________________________________
Whenandhowdoyougettheresults? ______________________________________________________________________
_________________________________________________________________________________________________________
Wherecanyougetmoreinformationaboutthistest? __________________________________________________________
_________________________________________________________________________________________________________
Othercomments:_________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
FOLLOW UP APPOINTMENT FORM SECTION
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MEDICATIONS AND TREATMENTS(Make multiple copies o this page in case your medical provider orders multiple medications or treatments)
If you have any concerns or reasons why you might not be able to follow the treatment recommendations, state them during the appointment.
Note: When you pick up your medications, read the label and make sure it states the same information your medical provider told you.
Doyouneedanymedicationortreatment?qYes qNo
if ys, cm h fwg:
Name o medication or treatment: _____________________________________________________________________________
Isagenericformavailable?qYes qNo_______________________________________________________________________
Doestheproviderhaveanysamplesintheofcesoyoucantrythemrst?qYes qNo
Reason or the medication or treatment: _______________________________________________________________________
Howmuchshouldyoutake? _________________________________________________________________________________
Howoftenshouldyoutakeit?________________________________________________________________________________
Whenshouldyoutakeit?____________________________________________________________________________________
Howlongwillyouneedtotakethismedicationfor? _____________________________________________________________
Willitinteractwithanyothermedicationsorsupplementsyouaretaking? qYes qNo ______________________________
Shouldyoutakeitwithorwithoutfood? _______________________________________________________________________
Whatshouldyouavoidwhiletakingit,suchasalcohol,grapefruitjuice,drugs,certainfoods,oractivities?
___________________________________________________________________________________________________________
Whatarethepotentialbenets? ______________________________________________________________________________
Whatarethechancesitwillwork?____________________________________________________________________________
Whatarethemajorrisksandsideeffects? _____________________________________________________________________
Howcommonaretheserisksorsideeffects?___________________________________________________________________
Howsoonshouldyouexpecttoseeresults?___________________________________________________________________
Iftherearesideeffects,aretherewaystomanagethese? qYes qNo
Arethereanysideeffectsyoushouldreportorthatmaybepotentiallyurgent? qYes qNo _________________________
Whatmighthappenifyouavoidedordelayedtakingthismedicationortreatment? _________________________________
___________________________________________________________________________________________________________
Arethereotheroptions?qYes qNo _________________________________________________________________________Wherecanyougetmoreinformationaboutthistreatment? _______________________________________________________
Other questions or comments: _______________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
FOLLOW UP APPOINTMENT FORM SECTION
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SURGICAL OR MEDICAL PROCEDURES
I you have any concerns or reasons why you might not be able to ollow the treatment recommendations, state them during the appointment.
Name o procedure: ________________________________________________________________________________________
Reason or the procedure: ___________________________________________________________________________________Whatisinvolvedwiththeprocedure? __________________________________________________________________________
Will you need any anesthesia qYes qNoifyes,whatkind?_________________________________________________
Whatarethepossiblebenetsoftheprocedure? _______________________________________________________________
Whatarethepossiblerisksorcomplications? __________________________________________________________________
Howcommonarethese?____________________________________________________________________________________
Whatarethechancesitwillwork?____________________________________________________________________________
Howsoonshouldtheproceduretakeplace?___________________________________________________________________
Arethereothereffectivebutlessinvasiveoptions? _____________________________________________________________
Whatmighthappenifyouavoidordelaytheprocedure? ________________________________________________________
Whatdoyouneedtodotopreparefortheprocedure? __________________________________________________________
Name o person perorming the procedure: ____________________________________________________________________
Howmuchexperiencedoesthesurgeon/doctorhavewiththisprocedure? ________________________________________
Willaresidentbeworkingwiththesurgeonordoctor? qYes qNo ______________________________________________
Whowillactuallybeperformingtheprocedure? _________________________________________________________________
Wherewilltheprocedurebeperformed? _______________________________________________________________________
Howlongwilltheproceduretake? ____________________________________________________________________________
Howlongwillyouhavetostayaftertheprocedure? _____________________________________________________________
Willyouneedsomeonetodriveyouandcareforyouaftertheprocedure? qYes qNo
Howlongistherecoveryperiod?_____________________________________________________________________________
Arethereanyrestrictionsaftertheprocedure? qYes qNo ______________________________________________________
Willyouhaveanydiscomfortaftertheprocedure? qYes qNo __________________________________________________
Howarepainandotherpost-procedureproblemstreated? ______________________________________________________
Ifabiopsyisinvolved,howandwhendoyougettheresults? ____________________________________________________
Wherecanyougetmoreinformationaboutthisprocedure? ______________________________________________________
Other questions or comments: _______________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Tip:It is your right to ask or a second opinion. It is oten a good
idea to get another opinion i the situation is complicated, or
i you have reservations about the procedure or surgeon.
FOLLOW UP APPOINTMENT FORM SECTION
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Beore your appointment
Prepare or the appointment by bringing the ollowing:
Briefsummaryofyourmainhealthconcern.
Questionsorconcernstocoverduringtheappointment.
Prioritize, starting with the most important.
Resultsofalllaborotherproceduresorderedbyanother medical provider. I you can, bring copies rather
than your own copy o your records.
Listofallmedicationsandsupplementsyoutake.
(see Medication and Supplement Historylog)
Anynewinformationorallergiestoaddtoyour medical records.
Medicalcardormedicalidenticationnumber.
Appointmentbookorcalendar.
Itishighlyrecommendedthatyoubringanadvocate
with you to your rst ew or any complicated medicalappointments. This can be a riend, amily member or
someone rom your support group.
During your appointment
Start with your main problem. Be brie and clear. Describe
your symptoms and how these aect you. I this is arecurring problem, explain how it aected you and whatwas done.
I you have more questions or concerns, tell your medicalprovider. Ask your provider i you should state all your
concerns now or ater you have discussed the mainproblem rst.
I medications, tests, surgery or other procedures are ordered,
write down:
Nameofthemedications,tests,surgeryorprocedures.
Thereasonforthemedications,tests,surgery
or procedure.
Therisksinvolved.
Thepotentialbenets.
Whathappensifyoudelayoravoidthemedication,test, surgery or procedure.
Howtotakethemedicationorprepareforthetest
or procedure.
Ifyouarereferredtoanotherspecialist,nurse,dietician,etc., what is the name and reason.
Howwillyoundoutyourtestresults.
At the end o the appointment
Arethereanysymptomsordangersignstobeawareof.Isthereanythingelseyouneedtoknow.
Doesyourproviderwantyoutocallorreturnforanother appointment.
Ater your appointment
During or immediately ater the appointment, you or your advocate
should write down the ollowing:
Thenameofyourmedicalproblem(diagnosis).
Whatthemedicalproviderwantsyoutodonext.
Whatchangesyoucanmakethatmayhelpyourproblem
Everythingyoucanrememberthatyourprovidertoldyou.
T HI R T eeN
Medic appintment Checkit: The shrt frm
This orm is or those who preer a shorter version o the medical checklist.
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Here are a ew tips when calling your medical provider:
Inoneortwosentences,writedownthereasonforyour call.
Listyoursymptomsandhowlongyouhavehadthem.
Havecalendar,pen,andpaperavailablebeforeyoumake the call.
Ifthecallisforaprescriptionrell,leavethenameofthe
medication, the dose, amount, prescription number and
the name and phone number o your pharmacy.Makeyourcallrstthinginthemorning.
Writedownthenameofwhoyouspokewith.Thismaybe a nurse, receptionist or answering service.
Askwhenyoumightexpectareturncall.
Leavethephonenumberthathasthebestchanceof
getting through to you over the course o a day. Formany people this is a cell phone number. Few o us arein one place all day.
Keepthephonelineclearasmuchaspossible.Ifthereasonforyourcallcanberesolvedwitha
return message, state clearly i it is okay to leavea recorded message or to give the message tosomeone else who answers your phone. Because o
privacy regulations, medical providers will not leavemessages unless specically authorized to do so.
foU R T e e N
Cing yur Mdic Prvidr
You may need to call your medical provider or inormation, to renew aprescription, or to see i it is necessary to be seen in the oce.
This section oers ways to improve phone communication with your provider.
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Time spent seeing your medical provider is short. Here are some tips on how to set up a good appointment:
MondaysandFridaysareoftenbusierthantherestoftheweek. The best times to call or appointments are usuallybetween 10 a.m. to noon and rom 2 p.m. to 4 p.m.
Haveyourmedicalnumber,insuranceinformationandcalendar on hand.
Ifseeingyourmedicalproviderontimeisimportant,ask
or the rst appointment o the morning or aternoon.
Ifyourconditioniscomplicatedorifhavingextratime
is important to you, explain this at the time you makethe appointment. It can be rustrating to nd out that
you were scheduled or a 10-minute time slot when youactually needed 45 minutes.
Youmayalsotryaskingforthelastappointmentoftheday. However, keep in mind that you may have to wait
longer because i others arrived late, that will accumulateby the days end. Also, remember that on busy days, your
medical provider may not have had a minute to eat or sitdown. Even i you are sick, try to be considerate.
Whenmakingtheappointment,stateiftheappointment
is routine or urgent. I you think it is urgent, be preparedto explain why you think so. For instance, I have been
vomiting or the last 48 hours is urgent. For the last twoyears I get a mild stomach ache every time I eat mayeel urgent but it probably is not.
fI fT e e N
Mre Tip but Medic appintment
Iftheappointmentyouaregivenseemstoofaroff,ask i you can be put on a cancellation waiting list.Cancellations are more common than you may think.
Conrmyourappointmentafewdaysbeforeandthen
keep the appointment. It is amazing how oten peopledo not show up or appointments.
Beontime.Beingearlyisevenbetter.Planningtoarrive15 minutes early is a good rule o thumb.
Ifyouknowyouaregoingtobelate,calltheofce.
Sometimes you can still be seen.
Bepreparedtowait.Bringsomethingtooccupy
yoursel. There are many reasons why medical providerscan run behind in their schedules.
Ifyourproviderseemshabituallylate,callinadvance
and see i he or she is running behind. I appointmentsare running an hour behind, ask i you can arrive 45minutes later than your scheduled time.
Donottakefrustrationoutonthestaff.Ifyouhavebeen
waiting excessively long you can request an explanationGood manners go arther than irritability does.
Ifyouknowinadvancethatyourtimeisshort,tellthe
sta when you arrive or even call in advance. I youhave an appointment and need to be across town in
two hours, say so. Explain, Something has come upand I need to leave here by such and such time. Have Iallowedenoughtimetoseethedoctor?
Ifyourproviderwantsyoutoreturnforafollow-up,make
the appointment beore you leave the oce. Ask thesta to write the date and time down on a card with the
oce phone number so it is handy should you need tochange the appointment.
Ifyouneedtochangeorcancelanappointment,tryto do so at least 24 hours in advance. You may be
charged i you do not cancel within a certain time rame.Remember that other patients may need that time slot.
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R.N. Registered Nurse
RNs work in hospitals, clinics, homes and other communitysettings. They perorm many tasks such as making
patient assessments, educating patients, administeringmedications and other treatments. There are many types onurses such as advice nurses, public health nurses, clinic
nurses, surgical nurses, home health nurses and psychiatricnurses. RNs receive their training in a number o ways
and may have a bachelors degree, associates degree,or nursing school diploma. The addition o a C ollowed
by other letters signies that the nurse is certied in a
specialty. RNs are licensed and usually report to physiciansor other advanced level practitioners.
s I XT e e N
The Medic aphbet
Our health is in the hands o numerous people with a variety o letters trailing their names. For instance, nursescan have over 50 dierent abbreviations ater their names. What do these letters mean and what do these people
do?Hereareafewdenitionsofsomecommonabbreviationsformedicaloccupationsyoumayencounter:
M.A. Medical Assistant
MAs perorm routine clinical and clerical tasks. The MA
may be the person who escorts you to the examiningroom, takes vital signs, and asks you some general
questions. MAs are usually trained through a ormalprogram, but are not licensed. MAs are supervised byphysiciansornurses.(Note:Outsideofmedicine,MA
generallymeansMasterofArts.)
N.A. Nursing Assistant
NAs work in hospitals at the same level as MAs. NAs
may give patient baths, take vital signs, and help withpatients basic needs. NAs are supervised by nurses andare not licensed.
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L.V.N. or L.P.N. Licensed Vocational Nurse or Licensed Practical Nurse
These nurses unction in much the same way as RNs. They
are licensed, but have less education. The roles o LVNsand LPNs are slightly restricted rom those o RNs, but thereis a great deal o overlap. They are usually supervised by
RNs, physicians, or other advanced level practitioners.
N.P. Nurse Practitioner
NPs are highly trained advanced practice RNs, who
usually have at least a masters degree. Sometimes NPsmay have RNP, FNP or other letters ollowing their names.
These simply signiy a ocus in their education. The lawsdescribing the scope o responsibility dier betweenstates. NPs can work independently, but they usually work
under a physicians supervision. Usually the physiciandoes not need to be immediately present in order or an
NP to unction. They can prescribe medications, orderlab tests, and in certain cases, perorm some surgical
procedures and administer anesthesia.
P.A. Physician Assistant
PAs are highly trained mid-level practitioners who practiceunder the license and supervision o physicians. They
usually have at least a bachelors degree. In general, PAscan practice in all medical and surgical specialties provided
they are properly trained and supervised. Usually thephysician does not need to be present in order or a PA tounction. They can write prescriptions, order lab tests and
do other medical tasks oten perormed by physicians.
M.D. Medical Doctor
MDs have attended medical school and passed rigorous
licensing exams. They can be physicians or surgeons.There are a host o other letter combinations that can ollowMD. These are earned when the doctor has obtained some
advanced training, education or certication.
A note ABout HCV MediCAl SpeCiAltieS:
Gastroenterologists
These physicians specialize in diseases o the
digestive system. The liver is part o that system.
Hepatologists
These are gastroenterologists who specialize in liver
diseases. Hepatologists usually practice in medicalcenters that have liver transplant programs.
Therearemanyothercombinationsoflettersthatdesignateprofessionaldistinction.Pharmacist(PharmD),
dentist(DDS),doctorofosteopathy(DO),doctorofchiropractics(DC)physicaltherapist(PT),respiratorytherapist(RT)andsoon.ProfessionssuchasChinesemedicine,naturopathy,etc.alsohavetheirown
letter designations. I you see unamiliar abbreviations ollowing a name, ask about them. Proessionalshave earned those abbreviations and are usually happy to explain the meanings.
Each member o your healthcare team has a role. Although some have more training than others, theirtraining makes them more suited or specic tasks. Learn how each is involved i
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