For providers
Are you a medical care provider and wondering how you can support HEP’s work? Learn more below!
Refer a patient
Forms
Refer a patient for HEP’s Care Coordination Program
This form should be completed by a patient’s Medical Provider or Case Manager on behalf of a patient seeking or currently receiving hepatitis C treatment and who is interested in enrolling in HEP’s Care Coordination Program.
Please email the completed form to our Lead Care Coordinator, Russell, at russells@hep.org or fax it to (206) 299-0855.
Patient Release of Information / Authorization to Disclose
We take confidentiality seriously. Please complete this Release of Information form to share patient health information with us.