PLACE LABEL HERE
RABIES VACCINE AND TREATMENT ORDERS
EMERGENCY DEPARTMENT
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
DIAGNOSIS: Rabies Prophylaxis Vaccination for Non-Immunized Patients
 Actual (must use actual weight for pediatrics)
 Estimated
2. Allergies :_______________________________________________________
3. Clean all wounds with soap and water
4.  Consult Poison Control Center if needed for complex cases. Poison Control # 404-616-9000
1. Weight of patient: _____kg (Required)
SCHEDULED MEDICATIONS:
5.  Human Rabies Immune Globulin (HRIG) 20 units/kg
Physician to inject ____ml in the wound and _____ml IM x 1 dose each site
HRIG should not be administered in the same syringe as the rabies vaccine or in the same anatomical
site as the first vaccine dose
6.  Rabies Vaccine: Human Diploid Cell Culture Rabies Vaccine (HDCV), 1 ml IM deltoid x 1 dose
Day 0 (zero) is the date of this initial vaccine
7. Tetanus prophylaxis:
 DT (diphtheria and tetanus toxoids) 0.5 ml x 1 dose (< 7 years old)
 Td (tetanus and diphtheria absorbed) 0.5 ml IM x 1 dose (> 7 years old)
 Tdap (diphtheria, tetanus, and acellular pertussis booster vaccine) 0.5 ml IM x 1 dose
 TIG (tetanus immune globulin) 250 units IM x 1 dose
 Other: ____________________________________________________
FOLLOW-UP AT DISCHARGE:
8. Fax these orders to Outpatient Clinic for rabies vaccine series:
Rabies Vaccine: Human Diploid Cell Culture Rabies Vaccine (HDCV), 1 ml IM deltoid (day 3 dose)
Rabies Vaccine: Human Diploid Cell Culture Rabies Vaccine (HDCV), 1 ml IM deltoid (day 7 dose)
Rabies Vaccine: Human Diploid Cell Culture Rabies Vaccine (HDCV), 1 ml IM deltoid (day 14 dose)
9. Call the Outpatient Clinic and notify them of the patient’s future visit
Lawrenceville (Outpatient Treatment Center)
Phone: 678-312-4220
Duluth (Procedural Nursing Center)
Phone: 678-312-6646
______________
Date
___________________
Time
*1-26279*
Fax: 770-682-2209
Fax: 678-312-6645
_________________________________
Physician Signature
FORM 1-26279 REV. 04/2011
__________
PID Number
Send copy to pharmacy: _________
(initials)
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