Remdesivir

Please fax the following to our intake team. Fax number: (817) 336-1643

Referral form (everything highlighted in yellow must be filled out)

  • Progress note stating the patient is at high risk for severe disease.
  • Covid 19+ test from a facility (can’t be home test)
  • Patient demographic sheet
  • Medication list

PEMGARDA

Please fax the following to our intake team. Fax number: (817) 336-1643

Referral form (everything highlighted in yellow must be filled out)

  • Progress note stating patient is at high risk for severe disease
  • Patient demographic sheet
  • Medication list