This COVID-19 Patient Referral Form is for referring physician use only.

Thank you for referring your patient to VCU Health System.

We would like to inform you that Remdesivir is now approved by the FDA under an expanded use agreement.

We also have several clinical trials for COVID-19 at VCU Health System. If you would like your patient to be considered for these, we will greatly appreciate it if you can provide the following information to help us determine the best approach.

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Referring Physician Information
Patient Location Information
Patient Information
M-D-Y
Clinical Criteria
M-D-Y
Comments
M-D-Y H:M
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