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Immunization Collaborative Agreement

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Collaborative Agreement for Immunizations/ __________________________________ RPh/PharmD and ________________________________________ ________________________, MD/ , _____________________________ MD/ARNP/DO licensed in the State of Washington, do hereby authorize ______________________________, of ___________________________Pharmacy to prescribe and administer the vaccines listed in the protocol to infants, children and adults in accordance with RCW and WAC 246-863-100 of the State of Washington. In exercising this authority the pharmacists shall comply with the recommendations of the Advisory Committee on Immunization Practices (ACIP). The Pharmacist will document all vaccines administered as required by statute, and on each patient s personal Immunization record.

Immunization Collaborative Agreement The Collaborative Drug Therapy Agreements consist of an authorizing document and a protocol describing the activities of the pharmacist.

  Agreement, Collaborative, Collaborative agreement

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