Hepatitis C Treatment Plan

Note type: Hepatitis C Treatment Plan

Encounter date: [Encounter date]

Author/role: [Author name, credentials, and role]

Setting: [in-person / telehealth / phone]

Primary diagnosis: [chronic HCV / acute HCV]

Planned therapy: [Regimen name] — [Duration in weeks]; start [Intended start date / pending authorization]

Insurance/prior authorization status: [Approved / Submitted—pending / Not required / PA to be initiated] (Include if relevant.)

(For required decision points—fibrosis status, HBV status, renal function, pregnancy status—do not leave blank. Use "Unknown—ordered today: [test]" or "Not available—records requested from [source] on [date]".)

Reason for Visit

[Purpose of visit] (Keep concise, e.g., pre-treatment evaluation and plan for DAA therapy.)

HCV-Focused History

[Concise summary of HCV history including diagnosis date/context, prior treatment history, most recent HCV RNA with date, and liver-related symptoms]

• Diagnosis: [Year and context of HCV diagnosis]
• Prior HCV treatment: [treatment-naïve / treatment-experienced] — [Regimens, dates, response]
• Most recent HCV RNA: [HCV RNA (date): value]
• Genotype: [Genotype] (Include only if it influences regimen choice.)
• Liver-related symptoms: [Fatigue, RUQ discomfort, pruritus, edema, abdominal distension, confusion, bleeding tendency] (Document only items explicitly stated.)
• Decompensation indicators: [Ascites: present / absent / history] | [Hepatic encephalopathy: present / absent / history] | [Variceal bleeding: present / absent / history] | [Jaundice episodes: present / absent / history] | [Prior hospitalization for decompensation: yes / no]
• Cirrhosis status: [non-cirrhotic / compensated cirrhosis / decompensated cirrhosis / uncertain—evaluation in progress]
• Comorbidities relevant to regimen or monitoring: [HBV status; HIV; CKD/dialysis; pregnancy potential; transplant history; HCC history; cardiac disease; diabetes on glucose-lowering meds; anticoagulation; enzyme-inducing anticonvulsants] (Include only if applicable.)
• Transmission/reinfection risk factors: [Injection drug use: current / remote / never] | [Substance use status and supports] | [Other relevant risk factors]

Pertinent Past History

• [CKD stage and dialysis status]
• [Diabetes and treatment]
• [Cardiac disease/arrhythmia relevant to DAA safety]
• [Psychiatric conditions impacting adherence]
• [Substance use disorders and treatment supports]
• [Other liver diseases: MASLD, alcohol-related liver disease]
• [Liver transplant or other transplant history]
• [Bariatric or GI surgery relevant to absorption]
• [Family history of advanced liver disease/HCC] (Include only if it affects surveillance decisions.)

Social History

• Alcohol: [Amount and pattern] (Include counseling goal if liver disease present.)
• Substances: [Current use and harm-reduction supports]
• Adherence barriers: [Housing, transportation, other barriers]
• Pregnancy intention/contraception: [Status] (Include if relevant.)

Medications and Allergies

• Prescription medications: [Medication list with dose and frequency]
• OTC medications: [List; note acid-reducing agents with dose/timing]
• Herbals/supplements: [List] (Flag St. John's wort if present.)
• Allergies: [Drug/agent — reaction]
• Medication reconciliation: [complete / incomplete—reconciliation pending]

Objective Data

• Vitals: [BP, HR, RR, Temp, SpO2, Weight, BMI] (Include if obtained.)
• Physical exam: [General appearance] | [Scleral icterus/jaundice] | [Abdomen: tenderness, hepatosplenomegaly, ascites] | [Extremities: edema] | [Neuro: asterixis/mentation] | [Skin: spider angiomata, bruising] (If exam limited, state limitation.)
• Laboratory data:
  • [CBC (date): WBC, Hgb, Plt]
  • [Hepatic panel (date): AST, ALT, Alk Phos, Total/direct bilirubin, Albumin]
  • [INR (date): value] (Include if cirrhosis suspected/known.)
  • [Renal function (date): Creatinine, eGFR]
  • [Quantitative HCV RNA (date): value]
  • [HIV status (date): result]
  • [HBV status (date): HBsAg, anti-HBc, anti-HBs, HBV DNA if indicated]
  • [Pregnancy test (date): result] (Include if applicable.)
  • [Other pertinent labs (date): value] (Document "ordered (date), pending" for pending items.)
• Imaging/procedures:
  • [Ultrasound/CT/MRI (date): findings relevant to cirrhosis/HCC]
  • [Elastography (date): kPa and interpretation]
  • [Liver biopsy (date): fibrosis stage]
  • [Endoscopy (date): varices and grade] (Include if cirrhosis present.)

Fibrosis Staging and Liver Disease Severity

Staging statement: [non-cirrhotic / cirrhosis—compensated / cirrhosis—decompensated / staging uncertain due to (reason); treating as (higher-risk category) pending (confirmatory test)]

• Evidence basis:
  • [FIB-4 (date): value] — Inputs: Age, AST, ALT, Platelets
  • [Elastography (date): kPa and interpretation]
  • [Imaging findings suggestive of cirrhosis/portal hypertension]
  • [Platelet trend]
  • [Biopsy (date): stage] (If available.)
• Child-Pugh (if cirrhosis): [Class A / B / C; score and components]

Eligibility and Preconditions

• Treatment exposure: [treatment-naïve / treatment-experienced] — [meets / does not meet / pending]
• Cirrhosis status: [none / compensated / decompensated / uncertain] — [meets / does not meet / pending]
• HBV status known and addressed: [meets / does not meet / pending] (If HBsAg+, document HBV DNA and prophylaxis plan.)
• HIV status known and addressed: [meets / does not meet / pending]
• Pregnancy status addressed: [meets / does not meet / pending / not applicable]
• Renal function category: [eGFR ≥30 / eGFR <30 / dialysis] — [meets / does not meet / pending]
• HCC status assessed: [meets / does not meet / pending]
• Transplant history reviewed: [meets / does not meet / pending / not applicable]
• Ability to adhere: [meets / does not meet / pending] — [Barriers and mitigation]
• Simplified pathway eligibility: [eligible / not eligible—reason / pending] (If not eligible, indicate specialist guidance is being followed.)

Assessment

• Chronic HCV: [Genotype if regimen-impacting] — [HCV RNA (date): value]; [treatment-naïve / treatment-experienced]
• Fibrosis/cirrhosis status: [Staging per above], [compensated / decompensated], [Child-Pugh if applicable]
• HBV status: [HBsAg/anti-HBc/anti-HBs results and plan] (Do not infer; use "Unknown—ordered today" if not available.)
• Comorbidities affecting regimen/monitoring: [Renal function, pregnancy potential, diabetes, anticoagulation, cardiac disease, transplant/HCC status]
• Reinfection risk considerations: [Present / absent; counseling and supports as applicable]

Plan

HCV Antiviral Regimen

Chosen regimen: [Medication name(s)] — [Dose, frequency, food requirements]; Duration: [X weeks]; Planned start: [Date]; Estimated end: [Date]; SVR12 target date: [Date]

Rationale: [Appropriateness for fibrosis/cirrhosis category, renal function compatibility, pregnancy status, prior treatment exposure]. [Alternatives not chosen due to: DDIs / contraindications / access / guideline preference]. (If ribavirin included, document anemia monitoring and pregnancy prevention requirements.)

Drug-Drug Interaction Review

DDI resource and date checked: [Tool/source] — [Date]

• [Concomitant medication]: [Interaction risk] — [Action: stop / switch / adjust dose / separate timing / monitor]
• [High-risk categories addressed]: [Statins, antiarrhythmics, anticoagulants, diabetes medications, enzyme inducers, acid-reducing therapy] — [Actions taken]
• Patient advised to notify clinic before starting any new medications or supplements during therapy

Baseline Orders

• HCV-specific: [Quantitative HCV RNA; genotype if indicated]
• Safety labs: [CBC, CMP/hepatic panel, INR if cirrhosis, Creatinine/eGFR]
• Coinfections: [HBsAg, anti-HBc, anti-HBs ± HBV DNA; HIV Ag/Ab]
• Pregnancy testing: [Urine/serum hCG] (If applicable.)
• Fibrosis assessment: [Elastography / FIB-4 / imaging] (If needed.)
• Vaccinations: [HAV series if susceptible; HBV series if susceptible]
• Referrals: [Hepatology/ID; addiction services; nutrition; social work; OB if pregnancy potential]
• (Note any labs requiring repetition due to age of results.)

Monitoring Plan

• Follow-up schedule: [At start / mid-therapy / end of treatment / as needed] — Minimal monitoring pathway: [applies / does not apply]
• Enhanced monitoring (if applicable):
  • [Cirrhosis/advanced disease]: [Visit/lab frequency; decompensation surveillance]
  • [HBV coinfection]: [HBV DNA monitoring vs prophylaxis plan]
  • [Ribavirin use]: [CBC schedule; dose adjustment criteria]
  • [Significant DDIs]: [INR checks, glucose monitoring]
  • [Renal impairment]: [Renal lab frequency and thresholds]
• Escalation criteria (urgent evaluation): Worsening jaundice, confusion, GI bleeding, increasing abdominal girth, severe fatigue/dyspnea, allergic reaction, chest pain/syncope

SVR Documentation Plan

• Test: Quantitative HCV RNA at ≥12 weeks after end of treatment — [Order placed (date)]
• Post-treatment interpretation: [SVR12 achieved—RNA undetectable / Not cured—relapse or reinfection suspected] — [Next-step plan]
• Ongoing risk monitoring: [Annual HCV RNA and risk-reduction counseling] (If reinfection risk persists.)

Post-SVR Follow-up

• Non-cirrhotic: [No liver-related follow-up needed / Follow per comorbid liver disease]
• Cirrhosis/advanced fibrosis: [HCC surveillance: ultrasound ± AFP every 6 months] | [Variceal surveillance per guidelines] | [Portal hypertension management]

Patient Education

• [How to take regimen: dose timing, food requirements, missed dose instructions]
• [Adherence strategies]
• [Avoid starting new medications/supplements without clinic review]
• [Reinfection prevention and transmission risk reduction]
• [Vaccination recommendations: HAV/HBV if non-immune]
• [Alcohol and hepatotoxic exposure avoidance]
• [Pregnancy counseling: contraception requirements and timelines] (If applicable.)

Care Coordination

• [Specialty pharmacy and prior authorization status]
• [Communication to PCP/specialists]
• [Records requested from (source) on (date)]
• [Follow-up appointment scheduled]