1. 1. Purpose and objectives of immunization program.
2. 2. Target population.
3. 3. Name and address of medical director.
4. 4. A signed and dated medical directive.
5. 5. Screening criteria for inclusion and exclusion.
6. 6. Informed consent form.

7. 7. Immunization procedures.

   1. a. Dosage.
   2. b. Single or multiple dose administration.
   3. c. Injection site.
   4. d. Vaccine storage.
   5. e. Biohazardous waste disposal.
   6. f. Standard precautions.
8. 8. Post-immunization instructions.
9. 9. Emergency guidelines, including a signed medical directive for emergency treatment.

10. 10. Qualification of immunization providers.

    1. a. Virginia licensure as a registered nurse, licensed practical nurse, or pharmacist.
    2. b. Supervision of a licensed practical nurse provider.
    3. c. Current cardiopulmonary resuscitation training.
11. 11. Resource personnel and supervision.
12. 12. Sample of patient record with date, vaccine, dose, site, expiration date, lot number, and administering person's signature.

Pursuant to provisions of subsection I of § 54.1-3408 of the Code of Virginia, a protocol shall be submitted to and approved by the board prior to the administration of an adult immunization program that includes the following:

Statutory Authority

§§ 54.1-2400 and 54.1-3005 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 30, Issue 10, eff. February 27, 2014.