Model Standing Orders
The physician responsible for an immunization clinic must sign model standing orders. The signing physician (or someone covering for the signing physician) must be accessible to clinic staff by telephone or in person on the day(s) of the clinic. Nurses can then administer vaccine to patients who present to the clinic. The physician responsible for the clinic should also sign Model Standing Orders for Emergency Treatment so that nurses can respond to and treat adverse events that rarely occur following vaccination.

Please contact your local board of health to find out more about ordering hepatitis A Immune Globulin (IG).

Immune Globulin (Human) USP For Hepatitis A Postexposure Prophylaxis (PDF) pdf format of mso-ighusp-hepa.pdf
Massachusetts Department of Public Health's (MDPH) Immune Globulin (Human) USP For Hepatitis A Postexposure Prophylaxis Model Standing Orders contain indications for IG, the order, contraindications to IG, and a screening tool to be completed by a health care provider with the patient prior to administration of IG. A self-screening tool, to be completed by the patient and reviewed by a health care worker prior to administration of IG, may also be used.

General Protocols for Standing Orders (PDF) pdf format of General Protocols for MSOs
rtf format of General Protocols for MSOs
MDPH's General Protocols for Standing Orders contain detailed information regarding requirements for administration of all vaccines (i.e., vaccination requirements for persons administering vaccines, screening patients prior to vaccination, patient education requirements, consent requirements when a parent or legal representative is not present at the time of vaccination, vaccine storage and handling, general administration guidelines, documentation requirements, and post-vaccination adverse event reporting) and recommendations for drawing up vaccines in the mass vaccination clinic setting (i.e., viability of the vaccine, ability to identify vaccines in the syringe, and avoiding vaccine wastage).

Model Standing Orders for Emergency Treatment (PDF) pdf format of Emergency Treatment
rtf format of Emergency Treatment
MDPH's Emergency Treatment Model Standing Orders contain guidance for treatment of syncope, local reactions to vaccination, and mild and severe symptoms of anaphylaxis .

Please remember that these standing orders serve as models and may be adapted to the specific needs of your clinical setting.

Documentation

Vaccine Adverse Event Reporting System (VAERS) - www.vaers.hhs.gov
The VAERS program is a post-marketing safety and surveillance collaboration between the Centers for Disease Control and Prevention and the Food and Drug Administration. Information about adverse events and side effects that occur after the administration of US licensed vaccines should be reported to VAERS. VAERS reports may be completed electronically through the VAERS website or by mail (the paper form is available on the VAERS website or at MDPH, 617-983-6800).

Vaccine Administration Record (VAR)
Vaccine Administration Records from the Massachusetts Department of Public Health include all of the fields required for proper documentation of vaccine administration in accordance with the Guidelines for Compliance with Federal Vaccine Administration Requirements rtf format of Guidelines for Compliance w/ Federal Vaccine Admin Reqs
(RTF) and MDPH recommendations. The following VARs are specific for immunization clinics, children and adolescents, and adults.

Sample Provider Notification Letter (RTF) rtf format of record-provider-notification-sample.rtf
The Provider Notification Letter is a sample of a letter that should be given to patients who are vaccinated in a mass clinic setting. Patients can then notify their primary care provider about vaccine(s) received at the clinic by mailing them the letter or giving it to them at their next appointment.

Additional documentation materials including the Adult Immunization Record, the Lifetime Health and Vaccination Record (the "Blue Book") and the Hepatitis A Vaccination Card can be requested from the Massachusetts Department of Public Health, Division of Epidemiology and Immunization by calling 617-983-6800.

Information Sheet and Screening Tools

Human Immune Globulin Information Sheet (PDF) pdf format of mso-ighinfo.pdf
rtf format of mso-ighinfo.rtf
The Human IG Information Sheet provides facts and general information about Immune Globulin and its use.


This information is provided by Epidemiology Program within the Department of Public Health.