Elective IV Therapy Standing Orders & Protocol Bundle

The standing orders template that actually contains the clinical content.

Most IV therapy templates leave the formulations blank. This one doesn't. 84 pages, written by a nurse, with every drip, dose, diluent and infusion rate written out — plus emergency orders, screening criteria, the patient paperwork, and a medical director packet built to actually get signed.

What's inside — 84 pages, 7 parts

1 · Governance & legal architecture
The good faith exam → patient-specific order → nurse administers sequence, explained plainly. A 16-question state verification worksheet, a ready-to-send board inquiry letter, and a scope-of-practice matrix covering MD, NP, PA, RN, LPN and MA.

2 · Master standing orders — 24 sections
Prescriber authorization, eligibility, contraindications, required labs, vital-sign go/hold/stop thresholds, interaction screening, IV insertion, monitoring intervals, adverse reactions, discharge criteria, documentation, consent, storage, compounding, infection control, and re-signature.

3 · 28 clinical order sets — with real doses
Hydration · Myers' Cocktail (push and bag build) · Immune · Recovery · Migraine · Athletic · Beauty · Energy · Detox · Metabolic · Adrenal · Post-Surgical · Anti-Nausea · High-Dose Vitamin C ladder · NAD+ titration · 10 IV push medications · 10 IM/SQ injections. Every card lists components, doses, diluents, rates, contraindications, monitoring, and a prescriber initials line.

4 · Emergency standing orders
Anaphylaxis with full epinephrine dosing and a step-by-step sequence, vasovagal, hypoglycemia, infiltration and extravasation with grading, phlebitis, air embolism, suspected bloodstream infection, fluid overload, nerve injury, needlestick, chest pain. Plus an emergency positioning chart and complete crash kit inventory.

5 · Compliance & operations
Marketing claims in a say-this / not-that table. Required disclosure block. Mobile and in-home operations: environment screening, EMS-response exclusions, cold chain, sharps transport, solo clinician safety.

6 · Medical director review packet
A 2-page memo written for your prescriber explaining what they're being asked to sign. Responsibilities table, signature log, annual review calendar, 16-element chart audit tool, change control form.

7 · Forms, logs & check-offs — 11 forms
Patient health history & intake, medication and supplement reconciliation, informed consent for IV hydration and injection services, per-visit treatment and encounter record, RN IV competency check-off, adverse event report, extravasation event form, monthly emergency kit log, refrigerator temperature log, vendor diligence file, client aftercare sheet.

Appendix — full citation list (board position statements, package inserts, published protocols, USP, FTC, CMS), glossary, and an honest table of where published evidence conflicts.

Why this one is different

• The doses are actually in it. Competing templates leave the clinical content blank.
• The patient paperwork is included. Intake, medication reconciliation, informed consent and a per-visit treatment record — the four documents the standing orders require you to keep on file, which most templates tell you to go and find.
• Written by a nurse who understands the clinical and the business side.
• Full emergency standing orders — most templates have none.
• A medical director packet written for the physician, not for you.
• A state verification worksheet, because the rules changed in 2025 and 2026.
• Sources are named throughout, including where published evidence conflicts, so your prescriber can check anything against the original.
• Editable Microsoft Word template with real form fields — clickable checkboxes and fill-in fields that don't shift your layout when you type. Also supplied as a print-ready PDF (the PDF is for printing and reference; it is not a fillable form).

What you receive

• Editable Word (.docx), 84 pages
• The same document as a print-ready PDF
• Instant download — nothing shipped

Common questions

Is this specific to my state?
No template is, and any seller who says otherwise is overpromising. What's included is better: a 16-question state verification worksheet and a board inquiry letter you can send to get an answer in writing from your own board.

Will my medical director actually sign it?
Part 6 is written for them — a 2-page memo explaining what they're being asked to sign, what it does not commit them to, and their ongoing responsibilities. Every order card has its own initials line so they can approve some formulations and strike others.

Can I edit it?
Yes. It's a Word document. Add your logo, delete formulations you don't offer, rewrite anything your prescriber changes. The checkboxes and fill fields are real Word controls, so you can complete it on screen or print it.

Are the doses ready to use?
They are proposed order sets for your prescriber to review, amend or reject — which is how it has to work. Your prescriber sets the final orders for your practice and for each patient. What this saves you is starting from a blank page.

Disclaimer

These are do-it-yourself templates provided for informational purposes only. They are not drafted by a legal professional and do not constitute medical or legal advice. Purchasing or using this template does not make any practice compliant with any law, regulation or standard, and no outcome of any kind is promised. Every dose, rate and threshold is a sample for your supervising prescriber to review, amend or reject — nothing here is a recommendation to treat any person. This is a generic template; your jurisdiction may have additional or different legal requirements, including laws and board positions governing IV therapy clinics, mobile infusion services, delegation and compounding. Please review, complete, and have your supervising prescriber (and, where needed, a licensed attorney in your state) approve these documents before use. You are solely responsible for compliance with the laws of your jurisdiction. Elective IV therapy is not intended to diagnose, treat, cure or prevent any disease, and many preparations referenced are compounded and are not FDA-approved for the uses described.

Terms

Instant digital download — no physical item is shipped. Due to the nature of digital products, all sales are final. Licensed for the buyer's own single-business use; reselling, sharing, or redistributing the files is prohibited. © Codes & Culture.