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HIV Medication Claim Evaluation
Did you have side effects from an HIV medication?
Step 1 of 4
25%
Were you prescribed any of these medications? (select all that apply)
*
AccessPak w/Kaletra
AccessPak w/Viracept
Atripla
Complera
Cimduo
Stribild
Symfi Lo
Truvada
Viread
Unsure/other
Did you suffer any of these while on the medication? (select all that apply)
*
Abnormal GFR
Abnormal protein levels
High creatinine levels
Kidney Disease
Kidney Failure
Other Kidney Injury
Bone/tooth loss
Low bone density
Bone necrosis
Osteoporosis
Other Bone Injury
Other/Unsure
When did you experience these side effects?
*
Choose most recent
Before 2000
2000 - 2001
2001 - 2002
2003 - 2004
2005 - 2006
2007 - 2008
2009 - 2010
2011 - 2012
2013 - 2014
2015 - 2016
2017 - 2018
2019 - 2020
Please provide additional comments to help evaluate your case.
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* Based on your responses, you may qualify for compensation!
Name
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