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Standing Orders

Download Standing Orders for Immunizations 2020-21,
a comprehensive booklet of the standing orders below and other immunization resources

Immunization standing orders are approved protocols that authorize appropriately trained health care personnel to assess patient immunization status and administer vaccinations without a written provider order or examination. Strong evidence demonstrates standing orders are an effective strategy for decreasing vaccine-preventable disease burdens while allowing for the safe delegation of the immunization process. Based upon such evidence, the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices (ACIP), the Community Preventive Services Task Force, the American Academy of Pediatrics and the National Vaccine Advisory Committee all recommend the use of standing orders to increase access to quality immunization health care and to reduce missed opportunities for immunizations in both children and adults. Similarly, the Defense Health Agency Immunization Healthcare Division (DHA-IHD) strongly recommends the use of standing orders for vaccinations in children and adults within the Department of Defense (DoD).

The use of standing orders in the DoD is a requirement under Army Regulation 40–562; BUMEDINST 6230.15B; AFI 48–110_IP; CG COMDTINST M6230.4G (Immunizations and Chemoprophylaxis for the Prevention of Infectious Diseases). Standing orders allow eligible nurses and other health care professionals working within their scope of practice (as determined by their license and each Service and/or the Defense Health Agency [DHA]), to provide safe and efficient vaccine delivery in the absence of a privileged provider. All standing orders must be locally approved by a physician. A privileged provider must still be available to respond to a medical emergency when immunizations are given.

Please see below for examples of various standing orders; these are updated as needed. Standing orders will have to be downloaded and saved locally in order to add a digital signature. DHA Immunization Healthcare Division standing orders detail recommended practices for administering vaccines within the DoD; there will not be standing orders developed for every vaccine licensed for use in the United States.

How to Use Standing Orders
Information Paper: Standing Orders for Vaccine Delivery in the Department of Defense (DoD)
May 2020
2020 updates
Recent Changes to Pediatric Standing Orders
August 2020
Recent Changes to Adult Standing Orders
August 2020
Anthrax Date
Anthrax Vaccine Adsorbed (Adult)
June 2020
Chickenpox Date
Varicella (Chickenpox) Vaccine (Pediatric)
June 2020
Measles Mumps Rubella Varicella (MMRV) Vaccine (Pediatric)
June 2020
Varicella (Chickenpox) Vaccine (Adult)
June 2020
Haemophilus Influenzae type b (Hib)
Date
Haemophilus influenzae type b Vaccine (Pediatric)
June 2020
Haemophilus influenzae type b Vaccine (Adult)
June 2020
Hepatitis A Date
Hepatitis A Vaccine (Pediatric)
July 2020
Hepatitis A Vaccine (Adult)
July 2020
Hepatitis A-Hepatitis B Combination Vaccine (Adult)
June 2020
Hepatitis B Date
Hepatitis B Vaccine (Pediatric)
June 2020
Hepatitis B Vaccine (Adult)
June 2020
Hepatitis A-Hepatitis B Combination Vaccine (Adult)
June 2020
Human Papillomavirus (HPV) Date
Human Papillomavirus Vaccine (Pediatric)
June 2020
Human Papillomavirus Vaccine (Adult)
June 2020
Influenza Seasonal Date
Influenza Vaccine for Children and Adolescents
February 2020
Influenza Vaccine for Adults
October 2020
Japanese Encephalitis Date
Japanese Encephalitis Vaccine (Pediatric)
June 2020
Japanese Encephalitis Vaccine (Adult)
June 2020
Meningococcal Date
Meningococcal ACWY Vaccine (Pediatric)
June 2020
Meningococcal Group B Vaccine (Pediatric)
June 2020
Meningococcal ACWY Vaccine (Adult)
June 2020
Meningococcal Group B Vaccine (Adult)
June 2020
Measles-Mumps-Rubella Date
Measles Mumps Rubella Vaccine (Pediatric)
June 2020
Measles Mumps Rubella Varicella (MMRV) Vaccine (Pediatric)
June 2020
Measles Mumps Rubella Vaccine (Adult)
June 2020
Pneumococcal Date
Pneumococcal (PCV13) Vaccine (Pediatric)
June 2020
Pneumococcal Polysaccharide (PPSV23) Vaccine (Pediatric)
June 2020
Pneumococcal Vaccines (Adult)
June 2020
Polio Date
Inactivated Polio Vaccine (Pediatric)
June 2020
Inactivated Polio Vaccine (Adult)
June 2020
Rabies Date
Pre-Exposure Rabies Vaccine (Adult)
June 2020
Rotavirus Date
Rotavirus Vaccine (Pediatric)
June 2020
Shingles Date
Zoster (Shingles) Vaccine (Adult)
June 2020
Tetanus-Diphtheria-Pertussis Date
Diphtheria, Tetanus and Acellular Pertussis (DTaP) Vaccine (Pediatric)
June 2020
Tetanus, Diphtheria and Pertussis (Tdap-Td) Vaccines (Pediatric)
June 2020
Tetanus, Diphtheria and Pertussis (Tdap-Td) Vaccines (Adult)
June 2020
Typhoid Date
Typhoid Vaccine (Pediatric)
June 2020
Typhoid Vaccine (Adult)
June 2020
Yellow Fever Date
Yellow Fever Vaccine (Pediatric)
June 2020
Yellow Fever Vaccine (Adult)
June 2020
Adverse Events Following Immunization Date
Medical Management of Vaccine Reactions in Children and Teens in Community Settings
July 2019
Medical Management of Vaccine Reactions in Adults in Community Settings
July 2019

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