Standing Order Title

Rationale:

Organisation:

Sumner Health Centre, staff and related locations.

Scope and circumstances under which this Standing Order may be used:

Precautions and exclusions which apply to this standing order:

Medications, Indications, Dosage and Route of Administration:

Persons Authorised to use this Standing Order:

Qualified Registered Nurses who have completed training in the General Procedures referred to in the Standing Order Policy and the training specific to this Standing Order.

Countersigning and Audit:

Countersigning of this Standing Order is NOT required.

All Standing Order Documentation must be submitted to the Clinical Director for audit in accordance with the Standing Order Policy.

Definition of any Non-English Language Terms used in this Standing Order:

Additional Information:

Signed:

Name:

Title:

Date: