8.2 Immunizations & Vaccine Administration

8.2 Immunizations & Vaccine Administration

Quick Answer: Illinois pharmacists may vaccinate patients 7 years of age and older pursuant to a valid prescription or standing order by a physician licensed to practice medicine in all its branches, after appropriate training (including contraindications and adverse reactions), with notification to the patient’s physician and record retention—or under hospital P&T policies (225 ILCS 85/3(d)(4)(B)). COVID-19 and influenza also have a dedicated pathway in 3(d)(15) with ACPE training, basic CPR, 2 hours immunization CE per licensing period, registry review, and pediatric well-child counseling for patients under 18. Techs/student pharmacists may give COVID-19, RSV, and influenza (IM/intranasal) only under 225 ILCS 85/9.6 conditions. Rules in 68 Ill. Adm. Code 1330.50 add VIS, 5-year records, and I-CARE or PCP report within 30 days.

Immunization items are classic Area 2.2 and public-health quality stems. They reward precise age, authority, training, and reporting answers—not “pharmacists can give any shot to anyone.”

Two Complementary Statutory Tracks (Do Not Collapse Them)

Track A — General vaccination authority: 3(d)(4)(B)

Drug administration within the practice of pharmacy includes vaccination of patients 7 years of age and older pursuant to:

• A valid prescription, or
• A standing order, by a physician licensed to practice medicine in all its branches

except for vaccinations covered by paragraph (15), upon completion of appropriate training (including how to address contraindications and adverse reactions set forth by rule), with notification to the patient’s physician and appropriate record retention, or pursuant to hospital pharmacy and therapeutics committee policies and procedures.

Eligible vaccines under this track are those listed on:

• The CDC Recommended Immunization Schedule
• The CDC Health Information for International Travel (Yellow Book)
• The FDA’s Vaccines Licensed and Authorized for Use in the United States

Exam age number to lock: 7. Not 3, not 12, not “any age” as the default Illinois Practice Act answer for this authority.

Track B — COVID-19 and influenza pathway: 3(d)(15)

Paragraph (15) addresses vaccination of patients 7 years of age and older for COVID-19 or influenza (subcutaneously, intramuscularly, or orally as FDA-authorized/approved/licensed) under a list of conditions, including:

IDFPR Compliance Capsule guidance (2025) emphasizes that when ACIP-schedule conditions are harder to use for certain COVID products, pharmacists still rely on prescription or physician standing order authority under the general vaccination framework—and public-health standing orders (e.g., IDPH) can expand operational access. For the MPJE, know both the statutory conditions and that Rx/standing order remains a core lawful basis.

Standing Order (Immunization Context)

Recall 3(dd): a standing order is a specific order for a patient or group of patients from a physician licensed in all its branches in Illinois. In immunization practice:

• The order authorizes administration to eligible patients meeting criteria without a new individual prescription each time
• Patient-specific prescriptions remain valid alternate authority
• Protocols must still address severe adverse events (Part 1330.50)

Standing order ≠ verbal “sure, go ahead” from a nurse manager. It is a physician order structure recognized by the Act.

68 Ill. Adm. Code 1330.50 — Rules You Must Recite

Part 1330.50 operationalizes vaccinations/immunizations:

Qualifications (high-yield)

1. A pharmacist, or a student pharmacist or pharmacy technician under the direct supervision of a pharmacist, may administer vaccinations/immunizations to persons 7 years of age or older pursuant to a valid patient-specific prescription or a standing order by a physician licensed in all its branches.
2. Completing an ACPE-accredited (or Division-approved similar) training course is required. The supervising pharmacist has sole responsibility for evaluating appropriateness of each vaccination and maintains full responsibility/oversight when students/techs administer.
3. The pharmacist must maintain current Basic Life Support (BLS) for Healthcare Providers (AHA, Red Cross, ASHI, or Division equivalent).
4. CDC Epidemiology and Prevention of Vaccine-Preventable Diseases (current copy or electronic) must be available at the administration location.
5. Administration is by trained pharmacist or trained student/tech under direct pharmacist supervision as the Section describes.

Protocols, VIS, adverse events

• Follow physician-written protocols for administration and treatment of severe adverse events
• Maintain policies for handling/disposal of used supplies/contaminated equipment
• Provide the appropriate Vaccine Information Statement (VIS) before each vaccination; ensure adult patient or minor’s parent/legal representative is available and has the VIS
• Report adverse events to VAERS and to the primary care provider named by the patient

Recordkeeping and reporting

Keep vaccine administration records 5 years, including:

• Patient name, address, DOB
• Date of administration and site of injection
• Name, dose, manufacturer, lot number, beyond-use date
• Name/address of patient’s named primary health care provider
• Name or unique identifier of administering pharmacist
• Which VIS was provided

Reporting rule: A pharmacist who administers or oversees administration must ensure a report is made to I-CARE (Illinois Comprehensive Automated Immunization Registry Exchange) or to the primary healthcare provider named by the patient within 30 days of administration.

Technicians & Student Pharmacists: 225 ILCS 85/9.6

Do not assume every vaccine a pharmacist may give is automatically tech-delegable. Section 9.6 is specific.

Vaccines techs/students may administer (IM or intranasal)

Under supervision of an appropriately trained pharmacist, a registered pharmacy technician or student pharmacist may administer:

• COVID-19
• Respiratory syncytial virus (RSV)
• Influenza

…as FDA authorized/approved/licensed, subject to conditions, including:

1. Vaccination ordered by the supervising pharmacist
2. Supervising pharmacist readily and immediately available
3. ACPE-approved practical training including hands-on injection technique and recognition/treatment of emergency reactions
4. Current basic CPR certificate
5. Minimum 2 hours immunization-related ACPE CE during the relevant licensing period
6. Supervising pharmacist complies with recordkeeping/reporting
7. Supervising pharmacist responsible for adverse-event reporting compliance
8. Supervising pharmacist reviews vaccine registry or other vaccination records before ordering the tech/student dose
9. If patient is 18 or younger, tech/student informs patient and adult caregiver of well-child visit importance and refers as appropriate
10. COVID-19 ordered/administered per ACIP COVID recommendations or State Guidelines for Communicable Disease Prevention issued by the IDPH Director
    11–12. Comply with applicable state/federal conditions and other Act/rules on drug administration

Tech may also administer COVID-19 therapeutics under additional 9.6(b) conditions (FDA product rules, practical training, CPR, pharmacist immediately available, etc.).

What remains pharmacist judgment

Even when a tech injects, the supervising pharmacist evaluates appropriateness, orders the vaccination, stays immediately available, owns registry review and reporting systems, and cannot hide behind “the tech did it.”

Distinguish Protocol Vaccines from Individual-Rx Nuances (Without Inventing Extra Ages)

Stay inside verified statute/rule ages:

• Default Illinois Practice Act / 1330.50 age floor for pharmacist immunizations described above: 7 years
• Do not invent additional cutoffs (e.g., “pneumococcal only at 65,” “HPV only at 11”) unless a stem supplies a clinical ACIP fact and asks clinical judgment within lawful authority
• Distinguish who may order/authorize (physician Rx/standing order; pharmacist ordering under pathways that allow it) from who may inject (trained pharmacist; trained tech/student for COVID-19/RSV/influenza under 9.6)
• Hospital P&T pathways are alternate institutional authority—not a free community pass

Exam Scenarios

Scenario A — Age. Parent requests vaccines for a 5-year-old at a community pharmacy under ordinary 3(d)(4)(B)/1330.50 authority. 7+ is the statutory floor for that framework—do not approve under the “7 years and older” rule.

Scenario B — Training only. Pharmacist completed ACPE immunization training years ago but let CPR and immunization CE lapse while still vaccinating. Fails current CPR / CE conditions tied to immunizing practice.

Scenario C — Reporting. Pharmacist vaccinates adults all month and neither reports to I-CARE nor notifies named PCPs within 30 days. Rule violation under 1330.50.

Scenario D — Tech scope. Trained tech with CPR, under immediately available supervising pharmacist who ordered the dose after registry review, administers intranasal influenza. May fit 9.6. Same tech independently decides to give shingles vaccine without pharmacist order/supervision framework—outside the listed 9.6 vaccine set and conditions.

Common Traps

• Using another state’s age (3, 6, 12, 18) as Illinois’s default
• Forgetting standing order or Rx for the general vaccination track
• Ignoring 2-hour immunization CE, CPR/BLS, VIS, VAERS, 5-year records, 30-day I-CARE/PCP
• Assuming techs may administer all vaccines pharmacists may administer
• Missing that supervising pharmacists retain full responsibility for appropriateness

Study Checklist

1. Age 7+ for the core Illinois immunization authority discussed here
2. Authority = Rx or physician standing order (plus hospital P&T where applicable)
3. Training + adverse-reaction competence + physician/PCP notification + records
4. I-CARE or PCP ≤30 days; records 5 years
5. Tech/student: COVID-19, RSV, influenza only under 9.6 checklist

Section 8.3 applies the standing-order public-health model to opioid antagonists.