---
title: Hepatitis C Antiviral Medication Refill Request Form Template | Paperform
description: Streamline Hepatitis C antiviral refills with viral load monitoring, liver function tracking, and specialist approval. Built for infectious disease clinics and specialty pharmacies.
url: "https://paperform.co/templates/hepatitis-c-antiviral-medication-refill-request"
type: static
generatedAt: "2026-03-28T00:44:05.159Z"
---

[← Back to free form templates](/templates/)    ![Hepatitis C Antiviral Medication Refill Request](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hepatitis-c-antiviral-medication-refill-request.png)
    [Preview](https://_preview.paperform.co/ai-template/hepatitis-c-antiviral-medication-refill-request) [Use this template for free](/create?ai-template=hepatitis-c-antiviral-medication-refill-request)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Pharmacist](/templates/role/pharmacist/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
Managing Hepatitis C treatment requires careful coordination between patients, pharmacy teams, and infectious disease specialists. This **Hepatitis C Antiviral Medication Refill Request** form streamlines the prescription renewal process while ensuring all necessary clinical monitoring is documented and reviewed.

Designed for infectious disease clinics, hepatology practices, specialty pharmacies, and hospital systems managing Hepatitis C patients, this template captures essential information including current viral load results, liver function test values, adherence patterns, and side effect monitoring. The form routes refill requests directly to the treating specialist for approval, maintaining treatment continuity while supporting clinical oversight.

Built with Paperform, this template offers conditional logic that adapts questions based on medication type and treatment phase, plus calculation fields that flag concerning lab values requiring immediate attention. You can embed the form on your patient portal, send it via email before follow-up appointments, or use it as part of your pharmacy coordination workflow.

Connect this form to your EHR system, notify specialists via Slack or email when refills need review, and use **Stepper** to automate approval workflows—routing urgent cases to on-call providers and standard refills through your established protocol. With **Papersign**, you can capture required consent for continued treatment or insurance authorization, keeping all documentation connected to the original refill request.

Whether you're managing direct-acting antiviral protocols, monitoring treatment-experienced patients, or coordinating specialty pharmacy benefits, this form ensures nothing falls through the cracks while reducing administrative burden on your clinical team.
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