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SUBJECT: EFFECTIVE DATE

Page 1 of 9 SU BJE C T : MEDICATION REFILL STANDING ORDER EFFECTI VE DATE: July 2011 Oral contraceptives updated 8/10/11 Compliance definition, exclusions and numerous screening parameters updated 10/25/11 Clonidine monitoring updated 11/22/11 Statin monitoring updated 3/9/12 APPROVED FOR USE AS A POPULATION BASED STANDING ORDER BY: SU PE R SE D E S: July 2010 REVI EW DATE: July 2012 PURPOSE: To provide a process for RNs and Pharmacists to review and approve maintenance prescription refill requests. POLI CY: To provide in a safe, efficient manner, approval for a supply of medication for patients (this would also include supplies for maintenance medications, for example, insulin syringes). The RN or Pharmacist is the agent of the prescriber delegated to refill medications as per the following procedure. Prescriptions must clearly originate with authorized prescribers. PROCEDURE: 1.

medroxyprogesterone (Provera®) progesterone (Prometrium®) mammography (beginning at age 40) Pap (per Health Maintenance) Hypertension Ace Inhibitors Medications Monitoring captopril (Capoten®) benazepril/amlodipine (Lotrel®) serum creatinine enalapril (Vasotec®)

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