For providers

If you are a physician or nurse practitioner with a patient who meets eligibility criteria for Paxlovid treatment, please use one of the following forms:

  • Paxlovid Prescription Form – If you have a confirmed positive patient within three days of symptom onset and who fits the eligibility criteria, you can prescribe Paxlovid directly by completing this form.
  • COVID-19 Clinical Assessment Centre Paxlovid Referral Form – If you are unable to test the patient, you can complete this referral form, fax it to the COVID, Cold and Flu Care Clinic, and book an appointment (phone/weblink) for the patient to be tested. If you are unable to test for COVID-19 or need bloodwork drawn, please use this form. Using the same link. You can also fax it to 519-685-8215.

Practice Solution and Accuro digitized referral and prescription forms can be found on the South West Primary Care Alliance website (search for ‘Paxlovid’ using the search function). If you have any questions or trouble accessing these forms, please email [email protected].

Please note: These forms are intended for use by physicians and nurse practitioners only. If you are a community member who wants to self-refer to the COVID, Cold and Flu Care Clinic for a clinical assessment, please call 519-685-8500 ext. 75503.

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