Protocol Packages Order Form

Please use this order form to receive an EMAILED COPY of the most recent protocol package(s). The protocols will be mailed within the next five business days.
Please enter the required information below:
Email to:
Name (First/Last)
Email Address
Address
City, State Zip
Daytime Phone

Immunization Protocol Package

IMMUNIZATION PROTOCOL PACKAGE COST:

Long-Acting Injectable Protocol Package

The Pharmacist-Administered Injectables protocols package includes draft protocols for pharmacist administration of the following:
- Addiction treatment drugs administered in a long-acting or extended-release form, including medications indicated for relapse prevention;
- Antipsychotic drugs administered in a long-acting or extended-release form;
- Human immunodeficiency virus (HIV) treatment or prevention drugs administered in a long-acting or extended-release form;
- Hydroxyprogesterone caproate for pregnant women;
- Medroxyprogesterone acetate for non-pregnant women;
- Cobalamin, including cyanocobalamin, hydroxocobalamin, or any other FDA-approved vitamin B12 injection;
- Antibiotics;
- Denosumab or romosozumab;
- Methotrexate for non-emergent conditions; and
- Heparin, low molecular weight heparin, and factor Xa inhibitors
Please select the protocol you wish to purchase.
PHARMACIST-ADMINISTERED INJECTABLES PROTOCOL PACKAGE:
   - denotes required fields