Background: Chronic hepatitis C virus (HCV) infection remains a major global health concern. Approximately 55–85% of individuals with acute HCV infection progress to chronic disease, which is often asymptomatic. Therefore, early diagnosis and treatment are crucial to prevent long-term complications. This provided the rationale for our study to evaluate the clinical characteristics, diagnosis, and treatment outcomes of chronic HCV patients using direct-acting antivirals (DAAs), with comparisons by viral genotype. Aim: To compare the clinical features, diagnosis, and treatment outcomes of chronic hepatitis C according to viral genotypes. Materials and Methods: A total of 1203 chronic HCV patients attending the outpatient department of Arkhangai Provincial General Hospital were included in this prospective and retrospective cohort study. HCV genotyping was performed, and patients received DAA therapy. Clinical manifestations, laboratory findings, HCV RNA levels, and fibrosis scores (APRI and FIB-4) were assessed at baseline, at week 4 of treatment, and at 12 weeks post-treatment. Statistical analysis was conducted using SPSS version 26.0. Results: : Among all patients, 6.7% had liver cirrhosis, and 1.4% had previously received interferon-based therapy. Patients with cirrhosis more frequently reported fatigue, abdominal discomfort, insomnia, right upper quadrant pain and loss of appetite (p<0.001). Virologic response at week 4 was 98.9%, and sustained virologic response at 12 weeks post-treatment was 99.3%. The mean APRI score decreased from 0.71±0.67 to 0.31±0.54, and FIB-4 from 1.61±0.41 to 1.16±0.26 (p<0.001). The most common adverse events were fatigue, headache, and nausea. Conclusion Treatment outcomes were 99.5% in patients with genotype 1b, 100% in genotype 1a, and 75% in genotype 2, with statistically significant differences (p<0.001). Both APRI and FIB-4 scores significantly decreased after treatment, confirming the effectiveness of DAA therapy in improving liver fibrosis (p<0.001).