Eastern Liver Network
EASTERN HEPATITIS NETWORK LOCAL MDT REFERRAL DOCUMENTTreatment CentreResponsible PhysicianClinical Nurse SpecialistDirect telephone no.NHS emailPatient NameNHS numberHospital numberDate of BirthCountry of BirthEthnicityReferral DateReferred byGP practice/codeAddressHCV genotypeFibroscan scoreBiopsyOther evidence of cirrhosisYear of first HCV diagnosisHCV treatment historyCo-morbiditiesMedicationsIssues for discussion at MDT (for completion by local team)Local MDT discussion (for completion at MDT)Issues for discussion at MDT{Issues for discussion:24442}Reason for prioritisation{Reason for HCV Rx prioritisation WTHG:23165}MDT conclusion{HCV MDT recommendation:22652}Treatment recommended: {Proposed treatment:21746}Attendance***Please email completed document to add-tr.hepatitis@ ................
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