Standing Orders

Standing orders are protocols approved by a qualified health care provider. They allow patients to receive tests, vaccines, clinical services, or other health care without an individual prescription. They are not directives and do not require anyone to receive care. We use standing orders in a variety of settings for many kinds of health care. This page addresses public health standing orders issued by the Secretary of Health.

What authority does the Secretary of Health have to issue Standing Orders?

Enacted in 2024, RCW 43.70.183, authorizes the Secretary of Health or their designee to issue a prescription or standing order for any biological product, device, or drug. The goal is to control and prevent the spread of, mitigate, or treat any infectious or noninfectious disease or threat to the public health. The Secretary or their designee must hold a valid, unexpired, unrevoked, and unsuspended license in Washington and follow licensing requirements.

Steps for requesting and issuing a Standing Order

Steps for authorization and issue of standing orders for any biological product, device, or drug.

Step 1. Initial request submitted.

Step 2. DOH reviews request against criteria and consults with the Assistant Attorney General, as needed.

Step 3. DOH approves, schedules meeting for more info, or denies the request.

Step 4. Standing order is drafted for approved requests.

Step 5. Feedback is requested from Local Health Officers, Local Health Administrators, and other partners with relevant knowledge.

Step 6. Standing order is finalized.

Step 7. Standing order is posted to the Standing Order web page.

Step 8. DOH shares communications about the standing order availability.

Current Standing Orders

Naloxone (PDF): The statewide standing order serves as a prescription for naloxone, a medication that reverses the effects of an opioid overdose.

Naloxone Standing Order FAQ: English (PDF) | Russian - Русский (PDF) | Spanish - Español (PDF) | Vietnamese - Tiếng Việt (PDF)

School Epinephrine (PDF): This statewide standing order allows for more consistent epinephrine access in schools. Epinephrine is a medication used to treat the symptoms of anaphylaxis, a type of severe allergic reaction caused by foods, drugs, insect stings, and other allergens.

Epinephrine Standing Order FAQ: English (PDF)

Frequently Asked Questions

What is the purpose of a standing order issued by the Secretary of Health?

The purpose of a standing order issued by the Secretary of Health is to increase access to public health resources and services that meet a public health need. However, a standing order does not fill a coverage gap or systems issue. It is important we execute all options of addressing a public health need before considering a standing order.

How do I know if a standing order is a good solution for this issue?

A standing order may be a good solution if:

the issue is a public health need,
we attempted other options for addressing the issue, and
the potential standing order aligns with the authority granted by RCW 43.70.183.

What are some examples of standing orders?

During the COVID-19 public health emergency, the Secretary of Health issued standing orders for:

COVID-19 vaccines
COVID-19 testing
Influenza vaccines
Epi-pen auto-injectors

The Secretary of Health used temporary authority under the federal Public Readiness and Emergency Preparedness (PREP) Act that expired with the end of federal emergency declaration.

The Statewide Standing Order to Dispense Naloxone is another example of a standing order. People may take this standing order to a pharmacy to get naloxone instead of going to a health care provider to get a prescription. Organizations may also use this standing order to get naloxone.

Who can submit a standing order request?

Internal DOH partners, like DOH staff and leadership, and external partners, like community or professional organizations, can submit a standing order request.

Who is the point of contact for standing orders?

DOH’s Office of Policy, Planning, and Evaluation is the primary point of contact. For questions about standing orders, please email DOHStandingOrders@doh.wa.gov.

What is the extent of a standing order (e.g. disease/public health threat, geography, etc.)?

DOH can only issue standing orders for a biological product, device, or drug defined in state law, RCW 43.70.183. The purpose of a standing order is to control and prevent the spread of, mitigate, or treat any infectious or noninfectious disease or threat to the public health.

A standing order issued by the Secretary of Health is valid only in Washington state. The Secretary may make a standing order apply statewide or limit it to specific areas of the state. A standing order will include its geographic scope.

How long does it take to issue a standing order?