INFERGEN Progress Tracker Baseline Week 4 ~ through ~ Week 72
Previous Interferon Treatment:        
Liver panel (ALT/AST) __________ __________ __________ __________
HCV RNA Viral Load __________ __________ __________ __________
         
Retreatment        
Liver panel (ALT/AST) __________ __________ __________ __________
Viral Load PCR __________ __________ __________ __________
Viral Load TMA __________ __________ __________ __________
Hemoglobin/hematocrit __________ __________ __________ __________
WBC __________ __________ __________ __________
Neutrophil count __________ __________ __________ __________
Platelets __________ __________ __________ __________
Bilirubin/uric acid __________ __________ __________ __________
TSH __________ __________ __________ __________
Glucose __________ __________ __________ __________
Pregnancy __________ __________ __________ __________
Ocular exam __________ __________ __________ __________
Weight __________ __________ __________ __________
IFN dose __________ __________ __________ __________