Consent for Short-Term (2-Week) Antiretroviral Treatment Bridge
Indication for Use
You may be eligible to receive a short-term (2-week) supply of antiretroviral (HIV) medication to initiate treatment as early as possible if newly diagnosed, and/or to prevent interruption of therapy if you are already on treatment while awaiting updated laboratory results or follow-up care.
Starting or continuing HIV medication without delay is essential to suppress the virus, prevent resistance, and protect your immune system. This short-term bridge ensures uninterrupted care while your provider reviews your lab results and confirms your ongoing treatment plan.
Acknowledgment and Agreement
By selecting below, you acknowledge and agree to the following:
- I have a confirmed or newly diagnosed HIV infection.
- I understand this prescription is a temporary 14-day supply to allow immediate treatment initiation or to maintain continuity of therapy.
- I agree to complete all required follow-up labs and provider appointments as directed.
- I understand that ongoing or additional prescriptions depend on my lab results and clinical review.
- I understand that missing doses or stopping medication may lead to viral rebound, drug resistance, and worsening of my condition.
- I will seek immediate medical attention if I experience severe side effects, allergic reactions, or new/worsening symptoms (such as fever, rash, weakness, or confusion).
