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For each question, mark the answer and check the note to determine if the patient qualifies, does not qualify, or if further evaluation is needed.

1. Age

Are you between 18 and 85 years old? *
Note: Only patients within this age range qualify. If No → Disqualified

2. Prior Hepatitis C Treatment

Have you ever been treated with any direct-acting antiviral (DAA) drugs for hepatitis C? *
Note: Only DAA treatment-naïve patients qualify. If Yes → Disqualified

3. Chronic Hepatitis C Diagnosis

Do you have a confirmed diagnosis of chronic hepatitis C? *
Note: Must have positive anti-HCV antibody or HCV RNA. If No → Disqualified

4. Hepatitis C Viral Load

Do you know if your HCV RNA viral load is 1000 IU/mL or higher? *

Note: Viral load must be ≥ 1000 IU/mL to qualify. If No → Disqualified

5. Cirrhosis

Have you been diagnosed with compensated liver cirrhosis? *

Note: Patients with or without compensated cirrhosis qualify. If Not sure → Further medical records needed

6. Signs of Decompensated Liver Disease

Have you ever had ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, or other signs of liver failure? *

Note: Patients with decompensated liver disease do not qualify. If Yes → Disqualified

7. Hepatitis B Co-Infection

Have you been diagnosed with hepatitis B? *

Note: Hepatitis B co-infection excludes participation. If Yes → Disqualified

8. Amiodarone Use

Have you used amiodarone in the last 3 months or plan to use it during the study? *

Note: Recent or planned use of amiodarone excludes participation. If Yes → Disqualified

9. Prohibited Medications

Are you currently taking any medications that your doctor told you should not be combined with hepatitis C antiviral drugs? *

Note: Use of prohibited medications disqualifies. If Yes → Disqualified

10. Pregnancy or Breastfeeding

Are you currently pregnant or breastfeeding? *

Note: Pregnancy or breastfeeding excludes participation. If Yes → Disqualified

11. HIV Co-Infection (if applicable)

Are you HIV-positive? *
If Yes: 
Have you been on antiretroviral therapy (ART) for at least 8 weeks?
Is your latest CD4 count above 200 cells/mm³?
Is your HIV viral load undetectable?
Are you on ART medications compatible with this study?

Note: Must meet all criteria to qualify. If any answer is No → Disqualified

12. Participation in Other Clinical Trials

Are you currently participating in or planning to participate in another clinical trial with investigational drugs? *

Note: Must meet all criteria to qualify. If any answer is No → Disqualified

13. Significant Medical Conditions

Do you have any serious illnesses or medical problems that you think might interfere with this study? *

Note: Serious medical conditions may disqualify. Consult study doctor. If Yes → Further evaluation required

Preliminary Outcome

  • If all qualifying questions are answered appropriately and no disqualifying answers are given → Patient QUALIFIES for full clinical evaluation.
  • If any exclusion criteria are met → Patient DOES NOT QUALIFY.
  • If unsure or incomplete information → Further review or medical records needed.