Epinephrine Standing Order Frequently Asked Questions
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I have a current (2026) standing order generated before May 19th. How do I update my standing order to include nasal spray devices?
If you have a current (2026) standing order which was generated prior to the inclusion of nasal spray devices on May 19th, please submit a new standing order application. To do this, visit the standingorders.cdph.ca.gov and select “new users apply here” to start your application. Be sure to include requested authorization for both auto-injectors and nasal spray devices if you would like authorization for both devices. If you are an LEA applying for a childcare program(s) please list the official name(s) for which you are applying.
Are childcare facilities eligible to apply for the CDPH Epinephrine Standing Order?
California Education Code 49414 states that a childcare program, defined as a state or federally subsidized childcare program operated by, or under contract with, the local educational agency, including, but not limited to, a California state preschool program or Head Start program, or a childcare program, including, but not limited to, general childcare and development programs, are eligible for the CDPH Epinephrine Standing order.
How do I update or make changes to my standing order? For example, I need to change the quantity of epinephrine auto-injectors or nasal spray devices I requested for authorization.
Contact SafeSchoolsTeam@cdph.ca.gov to update your current standing order. Please include what information you wish to update or change in the body of your email. Once changes are made, a new PDF copy of the completed standing order will be sent via email to whomever completed your original application. Do not complete another standing order application.
Will CDPH be distributing epinephrine auto-injectors and nasal spray devices?
CDPH will not be distributing epinephrine auto-injectors or nasal spray devices. The CDPH Standing Order generates a standing order that can be used similar to a prescription to obtain epinephrine auto-injectors and nasal spray devices. It is acceptable at all California pharmacies but may result in an out-of-pocket cost that is not covered by Medi-Cal. Free auto-injectors are available to schools at EpiPen4Schools. Free nasal spray devices are available through neffyinSchools.
Is this a one-time program? Can I apply again after the expiration date?
The standing order can be renewed annually by completing another online application form so that a new set of epinephrine auto-injectors and nasal spray devices are available for each calendar year. The application to renew standing orders will become available on the first of January each year. Returning users should wait until after January 1st to renew for another calendar year if they have no changes to make to their standing order. Do not submit a second application before this date unless you are seeking a new standing order for nasal spray devices. If you need to make changes other than adding nasal spray devices, please contact us at SafeSchoolsTeam@cdph.ca.gov.
The EpiPen4Schools Program requires a completed Standing Order Certification Form with a physician's signature. Will CDPH be providing this?
The CDPH Standing Order will act as both your “prescription" and certification through the EpiPen4Schools program. The CDPH standing order is signed by California's Public Health Officer, Dr. Erica Pan, which fulfills the certification requirement. You can upload your CDPH Standing Order PDF in both required fields for the EpPen4Schools program.
How often does a standing order for epinephrine auto-injectors or nasal spray devices in California schools need to be renewed?
The CDPH Epinephrine Standing Order will automatically expire one year from the date that it is signed, which is the first of January of each year. The standing order can be renewed annually by completing another online application form such that a new set of epinephrine auto-injectors and nasal spray devices are available for each school site each year.
Why does the expiration date on the CDPH Epinephrine Standing Order expire December 31st of each year and not run on an academic calendar?
CDPH's Epinephrine Standing Order Program aligns with the EpiPen4Schools Program, which runs on a calendar year from January to December. We've received feedback that significant shipping delays often occur during the months of July, August, and September. We highly encourage standing-order recipients to order at other times to avoid any significant shipping delays.
What is the difference between the CDPH Epinephrine Standing Order and the EpiPen4School or neffyinSchools Programs?
The CDPH Standing Order application generates a standing order that can be used to obtain epinephrine auto-injectors and nasal spray devices. It is acceptable at California pharmacies but may result in an out-of-pocket cost that is not covered by Medi-Cal. Free auto-injectors are available to schools via an independent program not affiliated with CDPH at EpiPen4Schools.com. Free nasal spray devices are available to schools independent program not affiliated with CDPH at neffyinSchools. The EpiPen4Schools andneffyinSchools programs accept the CDPH standing order and can ship auto-injectors and nasal spray devices directly to schools, local education agencies, and county offices of education. CDPH cannot provide any information or updates on orders placed through the EpiPen4Schools or neffyinSchools programs. For questions on the status of your order, please reach out to EpiPens4Schools or neffyinSchools directly.
When an epinephrine auto-injector or nasal spray device is used, can I replace it? Do I need to complete another online application?
Refills can be obtained within the year if epinephrine is used in the course of treatment and will not count towards the four-device limit per delivery system, per school site, per year. You do not need to complete another online application. The CDPH Standing Order allows refills as needed, so it can be used to replenish your supply of epinephrine auto-injectors or nasal spray devices. For auto-injectors, see the EpiPen4Schools Replenishment Certification Form. For any questions related to refills through the neffyinSchools program, the preferred point of contact is Connectwithneffy@schoolhealth.com.
Can I request additional epinephrine auto-injectors or nasal spray devices for separate facilities/activities, such as athletic facilities, field trips, and so forth?
The maximum quantity of auto-injectors allowed by this standing order, either regular or junior, is four per school, per calendar year. The maximum quantity of nasal spray devices allowed by this standing order, either 2mg or 1mg, is four per school, per calendar year.
Are there resources for teachers/volunteers (field trips)?
For auto-injectors please visit the EpiPen4Schools Resource page. For nasal spray devices, please visit the neffyinSchools resources page for additional information, email neffyinschools at Connectwithneffy@schoolhealth.com.
Is it acceptable to use expired epinephrine auto-injectors or nasal spray devices in the event of an emergency? Can we use regular epinephrine auto-injectors on small children if junior epinephrine auto-injectors are not available? Can we use 2mg nasal spray devices on small children if 1mg devices are not available?
We recommend that you work with your district legal counsel to ensure that your planned use of epinephrine during potential life-threatening situations aligns with Education Code and is covered by California law with regard to life-saving medical interventions. We also recommend that you review the available resources from the California Department of Education in regards to the Administration of Epinephrine.
Will CDPH sign documentation other than this standing order, such as a prescription for schools requesting additional epinephrine auto-injectors or nasal spray devices?
Schools will need to work with a local physician if they prefer to use their own methods of obtaining epinephrine auto-injectors or nasal spray devices. CDPH will not sign additional paperwork beyond the Epinephrine Standing Order.
How should schools dispose of used or inoperable medications and devices?
Do not discard used, inoperable, or expired medications and devices in regular household, organization, or business trash or recycling bins. Schools should call Med Take Back California at (844) 4-TAKE-BACK (844-482-5322) or visit Med Take Back California to locate a licensed pharmacy drop-off or mail-back program, or contact their local Household Hazardous Waste facility or County Environmental Health Department for guidance.
For questions please contact SafeSchoolsTeam@cdph.ca.gov.