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Monoclonal Antibody (MCA) Therapy Request Form

For Provider Use Only

READ THIS! Important information for referring physicians

Stop!!! Important Information for referring physician

July 7th, 2022 Update: 
We now have a very limited supply of the FDA authorized monoclonal antibody Bebtelovimab available for high risk patients age 12 -18 yrs.

Expanded access for use on patients less than 12 yrs or less than 40 kg is not available.



  • The oral product Paxlovid is available for consideration and in TN is available only through certain pharmacies. The link to check on possibilities is: https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/. This link only lists participating pharmacies but does not list which ones have product in stock.


Order Form

We now have a very limited supply of the FDA authorized monoclonal antibody Bebtelovimab available for high risk patients age 12 -18 yo.

bebtelovimab