PATIENT CONSENT FORM FOR COVID-19 TREATMENT (Sotrovimab). As your provider has discussed with you, you have been diagnosed with COVID-19 (or SARS-CoV-2) or are at high risk after exposure to COVID-19. At the present time, there are few Food and Drug Administration (FDA) approved, or clinically proven therapies for treatment of COVID-19. As new clinical data emerges, local treatment guidelines have been developed and will be updated as new information becomes available. CDC guidelines reflect what is known about therapies that may work against the SARS-CoV-2 virus, have been used to treat other coronaviruses, or may theoretically target the underlying causes of virus-related severe lung conditions that make breathing difficult. The FDA has granted Emergency Use Authorization (EUA) to permit investigational therapies in patients with confirmed or suspected COVID-19. Investigational therapies are not approved for any indication. They are authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use under section 564(b1) of the Act, 21 U.S.C. § 360bbb-3(b) unless the authorization is terminated or revoked sooner. If checked below and signed, you consent to the use underIn order for you to be treated with the therapy by the Super Health Pharmacy team, you must sign this form to show that you agree to the use of investigational or off label treatments, that you have been informed of the benefits and risks of taking such therapies as well as the benefits and risks of declining or refusing such use. The pharmacy team will annotate the monoclonal therapy available below for your encounter and the particular therapy chosen is based upon availability. You will be provided a patient informational handout regards the specific monoclonal antibody infusion before the therapy begins. You have the right to refuse to take this treatment(s) for any reason. Sotrovimab is an investigational medicine consisting of monoclonal antibodies used for the treatment of COVID-19 in non-hospitalized adults and adolescents 12 years of age and older with mild to moderate symptoms who weigh 88 pounds (40 kg or more, and who are at high risk for developing severe COVID-19 symptoms or the need for hospitalization. The FDA has issued an Emergency Use Authorization (EUA) to permit the use of this unapproved medication. Clinical trials are ongoing to study its safety and efficacy. It is possible that the medications listed above may help to control your symptoms, slow or stop the growth of the virus, shorten the duration or lessen the severity of the illness in you. Possible benefits primarily include improvement in lung function (ability to breathe without assistance) and normalization of blood pressure. However, there is the possibility that these medications may be of NO direct medical benefit to you. Your condition may get worse. POSSIBLE RISKS AND KNOWN SIDE EFFECTS; It is possible that the medication prescribed may not improve your symptoms and not shorten the duration nor severity of the illness. It is possible that the medication will unexpectedly interfere with your ability to improve, hasten damage to the lungs or other organs, and shorten your life.