1. A. Authorization. A pharmacist who is qualified under subsection (C) is authorized to order and administer, without a prescription order, an immunization, vaccine, or emergency medication, including but not limited to epinephrine, corticosteroids, albuterol, and antihistamines, to an eligible adult patient or eligible minor patient.

2. B. Authorized immunizations and vaccines:

   1. 1. A pharmacist who is authorized under subsection (A) may order and administer, without a prescription order, the following:

      1. a. For an eligible adult patient, an immunization or vaccine that is:

         1. i. Recommended for adults by the United States Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP); or
         2. ii. Recommended by the CDC’s Health Information for International Travel; and
         3. iii. Not on the Arizona Department of Health Services’ list required under A.R.S. § 32-1974(H) and specified in A.A.C. R9-6-1301; and

      2. b. For an eligible minor patient, an immunization or vaccine that is:

         1. i. For influenza or a booster dose as described under A.R.S. § 32-1974(A)(3); or
         2. ii. Administered in response to an emergency declared by the governor; and

   2. 2. A pharmacist who is authorized under subsection (A) may order and administer an immunization or vaccine to an eligible adult patient or eligible minor patient in accordance with:

      1. a. A valid standing order, as defined in subsection (J). A pharmacist shall not order or administer an immunization or vaccine under a standing order that has expired or been revoked, superseded, or otherwise terminated; or
      2. b. A valid standing order issued by a county or tribal public health department or the Arizona Department of Health Services (DHS) or its authorized medical director even if the standing order differs from current CDC or ACIP guidance. A pharmacist shall not order or administer an immunization or vaccine under a standing order or DHS standing order that has expired or been revoked, superseded, or otherwise terminated.

3. C. Pharmacist qualifications. To be authorized to order and administer an immunization, vaccine, or emergency medication, including but not limited to epinephrine, corticosteroids, albuterol, and antihistamines, a pharmacist shall submit a completed application form, which is available on the Board’s website, to the Board and provide evidence the pharmacist:

   1. 1. Is currently licensed to practice pharmacy in this state;
   2. 2. Successfully completed a training program that meets the requirements specified in subsection (D); and
   3. 3. Has a current certificate in basic cardiopulmonary resuscitation.

4. D. Training program requirements. The provider of a training program for pharmacists to administer immunizations, vaccines, and emergency medications to an eligible adult patient or eligible minor patient shall ensure the training program includes:

   1. 1. Basic immunology and the human immune response;
   2. 2. Mechanics of immunity, adverse effects, dose, and administration schedule of available vaccines;
   3. 3. Response to emergency situations including the administration of emergency medications;
   4. 4. Administration of intramuscular injections;
   5. 5. Other immunization administration methods; and
   6. 6. Recordkeeping and reporting requirements specified in subsection (E).

5. E. Recordkeeping and reporting.

   1. 1. A pharmacist shall document the following for each immunization, vaccine, or emergency medication administered:

      1. a. Patient name, address, and date of birth;
      2. b. Date of administration and site of injection;
      3. c. Product name, dose, manufacturer’s lot number, and expiration date;
      4. d. Name and address of the patient’s primary-care provider or physician;
      5. e. Name of the authorized pharmacist or qualified intern or pharmacy technician who administered the vaccine and, if the vaccine was administered by a qualified intern or pharmacy technician, the name of the authorized pharmacist who supervised the qualified intern or pharmacy technician;
      6. f. Record of consultation confirming patient eligibility;
      7. g. Any patient education or consultation provided;
      8. h. Name and date of the vaccine information sheet provided to the patient; and
      9. i. For an eligible minor patient, a signed consent form from the parent or guardian.
   2. 2. As required under A.R.S. § 32-1974(E)(1), the pharmacist shall provide a report to the patient’s primary-care provider or physician containing the information required in subsections (E)(1)(a) through (d) within 48 hours after administration and document the report was provided within 72 hours.
   3. 3. A pharmacy’s pharmacist-in-charge or permittee shall ensure the records required in subsection (E)(1) are maintained for at least seven years from the administration date.
6. F. Confidentiality. A pharmacy permittee shall ensure compliance with all applicable state and federal privacy laws when patient health information is released.
7. G. Immunizations requiring a prescription order. A pharmacist shall not administer an immunization or vaccine listed in A.A.C. R9-6-1301 without a prescription order. The pharmacist shall comply with subsection (E)(1) if an immunization or vaccine listed in A.A.C. R9-6-1301 is administered.

8. H. Administration by an intern.

   1. 1. The Board authorizes an intern to administer an immunization, vaccine, or emergency medication, only if a pharmacist authorized under subsection (A) verifies the intern is currently licensed in this state, successfully completed a training program that meets the requirements specified in subsection (D); and has a current certificate in basic cardiopulmonary resuscitation.
   2. 2. An intern authorized under subsection (H)(1) may administer an immunization, vaccine, or emergency medication to an eligible adult patient or eligible minor patient only under the supervision of a pharmacist authorized under subsection (A).
   3. 3. An intern shall not independently order an immunization, vaccine, or emergency medication.

9. I. Administration by a pharmacy technician.

   1. 1. Before a pharmacy technician administers an immunization or vaccine, a pharmacist authorized under subsection (A) shall verify the pharmacy technician is currently licensed in this state, successfully completed a training program that meets the requirements specified in subsection (D), and has a current certificate in basic cardiopulmonary resuscitation.
   2. 2. A pharmacy technician qualified under subsection (I)(1) may administer an immunization or vaccine to an eligible adult patient or eligible minor patient only if the administration is delegated by the pharmacist on duty and under the direct supervision of a pharmacist authorized under subsection (A).

   3. 3. A pharmacy technician shall not:

      1. a. Order an immunization, vaccine, or emergency medication; or
      2. b. Administer an emergency medication.

10. J. Definitions. The following definitions apply to this Section:

    1. 1. “Eligible adult patient” means an eligible patient who is 13 years of age or older.

    2. 2. “Eligible minor patient” means an eligible patient younger than 13 years of age who meets the following minimum age requirements:

       1. a. For influenza vaccine: three years of age or older;

       2. b. For any other immunization or vaccine:

          1. i. Under a standard order or prescription order, three years of age or older; or
          2. ii. Without a standing order or prescription order, in accordance with A.R.S. § 32-1974(A)(1).
    3. 3. “Standing order” means a written directive issued by a licensed healthcare provider authorized by a county or tribal public health department or the Arizona Department of Health Services that allows an authorized pharmacist and other qualified pharmacy personnel, to order or administer immunizations, vaccines, or emergency medications to individuals who meet the criteria set forth in the standing order, in accordance with established clinical protocols, without needing a patient-specific prescription order. For the purpose of this Section, a standing order is a prescription order as defined at A.R.S. § 32-1901(87)(c) and required under A.R.S. § 32-1974(B). A standing order may include an effective and expiration date and shall not be relied on if expired, superseded, revoked, or otherwise terminated.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 3967, effective November 13, 2004 (Supp. 04-3). Amended by final rulemaking at 12 A.A.R. 279, effective March 11, 2006 (Supp. 06-1). Amended by final rulemaking at 14 A.A.R. 3674, effective November 8, 2008 (Supp. 08-3). Amended by final rulemaking at 15 A.A.R. 1930, effective November 3, 2009 (Supp. 09-4). Amended by final rulemaking at 17 A.A.R. 2596, effective February 4, 2012 (Supp. 11-4). Amended by final rulemaking at 23 A.A.R. 211, effective March 5, 2017 (Supp. 17-1). Amended by final rulemaking at 25 A.A.R. 1015, effective June 1, 2019 (Supp. 19-2). Amended by final rulemaking at 26 A.A.R. 223, effective March 14, 2020 (Supp. 20-1). Amended by final rulemaking at 28 A.A.R. 994 (May 13, 2022), effective July 2, 2022 (Supp. 22-2). Amended by emergency rulemaking at 31 A.A.R. 4007 (October 10, 2025), effective September 22, 2025, for 180 days (Supp. 25-3). The emergency rulemaking was due to expire on March 21, 2026; Before the expiration of the emergency, Section R4-23-411 was amended under final rulemaking at 32 A.A.R. 471 (February 27, 2026, Issue 9) with an immediate effective date of February 3, 2026 (Supp. 26-1).