Pre-Registration: VA HEPC Clinician & Care Team Training: Expanding Access to Hepatitis C Treatment

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VA HEPC Training: Empowering Clinicians, Care Teams, and Community Partners to Expand Hepatitis C Treatment Access

This program equips healthcare providers with the skills and knowledge to identify, treat, and cure hepatitis C (HCV) in their patient populations. Participants will gain a comprehensive understanding of the HCV care continuum, including screening, linkage to care, liver staging, medication selection, cost-effective treatment access, monitoring, and advanced liver disease management. Whether treating patients directly or linking them to care, attendees will leave empowered to make a meaningful impact on HCV outcomes.

Virginia HEPC and University of Washington Hepatitis Online

To prepare for the in-person or virtual training, we recommend completing HCV Test and Cure prior to attending. These modules provide essential foundational knowledge that will enhance your training experience. They also offer optional CNE/CME credits in addition to those provided for the VA HEPC training.

For details on Hepatitis Online and instructions on joining the VA HEPC group, visit virginiahepc.com/hepatitis-c-online.

Conference date to be set once 20+ people have registered

There is no cost for registration or attendance of this conference
The conference is anticipated to take place in Charlottesville, Virginia
The conference is usually held as a single-day session, running from 8:00 AM to 5:00 PM

Completing this form lets VA HEPC know you plan to attend the next training opportunity. Once at least 20 participants have committed, we will schedule the session. Your pre-registration indicates your intention to attend, recognizing that unexpected circumstances may arise.

Today's Date

* must provide value

M-D-Y

What is your role?

* must provide value

Licensed Independent Practitioner

Direct Patient Care Team

Community Partner (Leadership, Epidemiologist, other roles in the community)

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First Name:	Last Name:	Degree:	Degree/ Certification:
Title/ Role:	Best Contact Phone:	Phone Type:
Preferred Email Address:		Email Type:

If Training is Held in Charlottesville, I Plan on Attending

In Person

Virtually

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I would like to have the training held at my facility, or in my geographic area. I have 20+ people that would commit to attending in person training if held locally.

If yes is checked, someone will contact you for further information and coordination

Yes No

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Practice or Clinic Name:		Is Your Site an OBAT:
Street:		Affiliation:
City:	State:	Zip:
Practice Phone:	Ext:	Fax:
Alternate Email:		Website:

How would you like your name printed on your completion certificate?

T-Shirt Size

Small Medium Large XL XXL XXXL

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Are you currently treating hepatitis C?

Yes No

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Does your facility currently treat hepatitis C?

Yes No

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Do you hope to be treating hepatitis C within the next 6 months?

Yes No

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Would you like your facility to be listed on the VA HEPC Treatment Access Map?

Yes No I / we are already on the map

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Enter your practice information below to be listed on the VA HEPC Treatment Access Map

Have you previously attended or independently (Asynchronously) completed VA HEPC training?

Yes No

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Previous Training Type:

In Person Virtual Asynchronous

What barriers have you experienced, or do you anticipate, when trying to screen, start treatment, or refer patients for hepatitis C care at your site?

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What would you like this training to help you do more effectively in your work with patients affected by hepatitis C?

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Step in Process After HEPC Training?

Have you initiated any HCV screening, appointments, treatment starts and/or cures since you have completed training?

Yes No

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Number of patients who:

Were screened for HCV		Attended 1st appointment for HCV
Were prescribed treatment for HCV		Started treatment for HCV
Completed treatment for HCV		Completed SVR lab
Were cured of HCV		Date Updated
Please document the counts to the best of your ability: Place 0 in fields if you have not yet started. All fields do not have to be filled in for the cascade if you do not track throughout. This assists us in being able to show the value in our work and continue to provide ongoing education. Thank you for taking the time to share your impact!

Other

Would you like to be registered for our Community of Practice? COP is a virtual community that meets the 3rd Wednesday of each month from 4-5 pm to share case studies and continue learning about hepatitis C.

Yes No

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Opt out of Community of Practice?

Yes No

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Would you like to become a member of the Virginia Hepatitis Coalition? VHC meets the 4th Thursday of each month from 10 am to 11 am to discuss the state of hepatitis C elimination across the state. Multiple stakeholders join together to find solutions and to provide education and resources from multiple sources to combat viral hepatitis (A, B, C, and D) in Virginia.

Yes No

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Opt out of Virginia Hepatitis Coalition?

Yes No

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Please submit this form only if you fully intend to participate in the next training opportunity. We look forward to partnering with you in expanding access to hepatitis C care. If you have any questions, contact us at hepc@sentara.com

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