REACH-C

  • Reach-C
  • REACH-C online form

    Please fill out patient and doctor details below to have data reviewed by a specialist. Patient data is de-identified and collected for the REACH-C Study. We will contact you via email to provide the approval to treat. We will also contact via email when your patient has reached SVR12 (HCV RNA testing 12-weeks post-treatment) to confirm that they are cured.

    * Indicates required field

  • Select date DD slash MM slash YYYY
  • Prescriber information

  • 0 of 100 max characters
  • Please use personal work email if available (not general reception email).
  • Patient demographics

  • Select date DD slash MM slash YYYY
  • Clinical information

  • Please enter a number greater than or equal to 0.
  • Please enter a number from 0 to 99.
  • Please enter a number greater than or equal to 0.
  • Please enter a number greater than or equal to 0.
  • Please enter a number greater than or equal to 0.
  • HCV therapy

  • Select date DD slash MM slash YYYY
    If unknown, proposed date
  • You will be contacted by the REACH-C study team to collect the 12 week post-treatment outcome and adherence for this patient.

  • Information required for specialist approval

    The following information is required for specialist approval but will not be collected for REACH-C study
  • if weight is <100kg, add a 0 in front
  • Please enter a number from 0 to 99.
  • 0 of 1000 max characters
  • 0 of 1000 max characters
  • Please check result from HEP Drug Interaction Checker at http://www.hep-druginteractions.org/
  • E.g. note any change in medication, dose reduction required
  • 0 of 2000 max characters
  • This field is hidden when viewing the form

    SPECIALIST APPROVAL

  • This field is hidden when viewing the form
    0 of 30 max characters
  • This field is hidden when viewing the form
    0 of 100 max characters
  • This field is hidden when viewing the form
    Select date DD slash MM slash YYYY
    (dd/mm/yyyy)
  • This field is hidden when viewing the form
  • This field is for validation purposes and should be left unchanged.