California Hepatitis C Clinicians' Honor Roll Pledge Form

The California Hepatitis C Clinicians' Honor Roll will be widely publicized among clinical peers, patients, and the general public via the website of the seven collaborating organizations. The goal of the California Hepatitis C Clinicians' Honor Roll is to make hepatitis C screening standard of care for susceptible populations within the primary care setting. Your pledge will go a long way toward the elimination of hepatitis C transmission and the prevention of liver disease and liver cancer in California. For more information, contact cafp@familydocs.org, ehuriaux@projectinform.org or call (415) 580-7301.

Clinician Pledge

I pledge to be a Hepatitis C Champion by screening patients at risk for hepatitis C in accordance with the national guidelines published by the United States Preventive Services Task Force.

1. Full name, with professional degree: *This question is required.

2. Practice City *This question is required.

3. Please check here if you are interested in additional information:

Please add me to the Honor Roll email list for ongoing communications.
I\'m interested in educational activities.
I'm willing to serve on a work group, task force, or as a faculty member or spokesperson.
Other Please enter an 'other' value for this selection.

4. Email (optional):