United States Peace Corps

1111 20th St NW
Office of Health Services
Washington, DC 20526

RN PCMO Standing Orders: Country:

The above named Registered Nurse is authorized to treat Volunteers/patients with the CHAM
Assessments/Protocols and/or Peace Corps Technical Guidelines that are highlighted below according to the plan listed
in the 2006 Community Health Aide/Practitioner Manual (CHAM) and/or the Peace Corps Technical Guidelines (TG).

It is not necessary for the RN to contact the Supervising Physician (Chief, Clinical Programs or designee) for the
highlighted conditions/assessments unless the problem is severe or the protocol directs the RN to do so. For all other
conditions/assessments, the RN must follow the plan in the CHAM and report according to the specific plan or other
approved Peace Corps protocol. These Standing Orders must be re-authorized and signed every two years or when a
change of Supervising Physician(s) occurs.
RN Standing Orders
Clinical Supervising
CHAM Section Plan and Standing Order Competence Physician
Page Number Initial/date* Initial/date

PCMO has demonstrated competency in all areas and is granted

Standing Orders for the following conditions
Eyelid 3, p. 221
Musculoskeletal 10,p. 425
Respiratory, p 312
Adolescent/Teen 1, p. 181
Alcohol/Drug 2, p. 724
Birth Control 3, p. 548
Birth Control 4, p. 551
Birth Control 5, p. 552
Birth Control 6, p. 553
Burn 3, p. 472
Burn 4, p. 472
Circulatory 10, p. 350
Circulatory 11, p. 353
Circulatory 2, p. 332
Digestive 1, p. 361
Digestive 10, p. 384
Digestive 16, p. 389
Digestive 18, p. 392
Digestive 6, p. 375
Ear 3, p. 240
Ear 2, p. 239
Ear 6, p. 243
Ear 7, p. 244
Eye 1, p. 226
Eye 4, p. 228
Eyelid 2, p. 221
Eyelid 4, p. 222
Female 1, p. 520
Female 6, p. 525
Female 9, p. 527
TG 605 Attachment A
Insect Bite or Sting to Eyelid or Mild Allergic
Reaction
Musculoskeletal Injury: Other (includes
bruise, swelling, muscle strain)
Shortness of Breath: Pneumothorax
Plan: p 53, Emergency 8 (Collapsed Lung)
Teen/Adolescent Health Care/Maintenance,
Includes Immunizations
Hangover
Contraception: Changing Birth Control Method
Contraception: Refill Pills, or Patch,
Contraception: Repeat Depo-Provera Shot
Emergency Contraceptive Pills (ECPs)
Minor Burn, 1st Degree
Minor Burn, 2nd Degree
Hypertension, Chronic Care
Heart Disease, Chronic Care
Anemia; Iron deficiency
Minor Abdominal Injury
Hemorrhoids or Anal Fissure
Constipation
GERD, Chronic Care
Gastroenteritis
Acute Otitis Media
Otitis Media with Effusion
Otitis, External
Object in Ear Canal-Foreign Body
Conjunctivitis
Blood on Sclera (Subconjunctival hemorrhage)
Blepharitis
Stye
Vaginal Discharge, Possible Yeast Infection
STI: Patient with Positive Gonorrhea Test or
Positive Chlamydia Test
STI: Sore or Rash on Genitals: Possible Genital
Herpes, Recurrent Sores
January 2016

Office of Health Services
RN PCMO Standing Orders:
Female 17, p. 556
Male 3, p. 502
Male 4, p. 502
Male 6, p. 503
Mouth 1, p. 254
Mouth 3, p. 255
Mouth 4, p. 256
Mouth 5, p. 256
Mouth 6, p. 257
Mouth 8, p. 259
Musculoskeletal 5, p. 420
Musculoskeletal 6, p. 421
Musculoskeletal 7, p. 422
Musculoskeletal 8, p. 423
Nervous 2, p. 624
Nervous 20, p. 651
Pregnancy 2, p. 567
Respiratory 1, p. 288
Respiratory 11, p. 304
Respiratory 13, p.305
Respiratory 15, p. 307
Respiratory 16, p. 308
Respiratory 17, p. 309
Respiratory 18, p. 317
Respiratory 19, p. 321
Respiratory 2, p. 296
Respiratory 21, p. 324
Respiratory 3, p. 297
Respiratory 5, p. 298
Respiratory 6, p. 299
Respiratory 7, p. 300
Respiratory, p 312
Respiratory, p 313
Respiratory, p 314 (SOB1)
Respiratory, p 314 (SOB2)
Skin/Soft Tissue 1, p. 38
Skin/Soft Tissue 11, p. 448
Skin/Soft Tissue 12, p. 449
Skin/Soft Tissue 13, p. 450
Skin/Soft Tissue 14, p. 450
Skin/Soft Tissue 2, p. 38
Skin/Soft Tissue 3, p. 439
Skin/Soft Tissue 4, p. 441
Skin/Soft Tissue 5, p. 441
Skin/Soft Tissue 8, p. 445
Skin/Soft Tissue 9, p. 446
Urinary 1, p. 490
Wounds 1, p. 462
TG 605 Attachment A
United States Peace Corps
1111 20th St NW
Washington, DC 20526
Country:
Breast and Cervical Cancer Screening
STI: Patient with Positive Gonorrhea Test or
Positive Chlamydia Test
Genital Rash, Possible Fungal Infection
STI: Sore or Rash on Genitals: Possible Genital
Herpes, Recurrent Sores
Canker Sores- Stomatitis
Mouth Herpes, Recurrent Sores
Mouth; Sore Corners of
Hand, Foot, Mouth Disease
Thrush
Irritation from Dentures
Sprain
Neck Pain with Muscle Strain
Low Back Pain with Muscle Strain
Minor Bruise Under Nail-Subungual Hematoma
Muscle Tension Headache
Chronic Pain, Chronic Care
Negative Pregnancy Test
Minor Chest Injury
Bronchitis
Pneumonia
Asthma Attack
Wheezing, Other illnesses with
Respiratory illness, other
Lung Disease, Chronic Care
TB Screening: PPD
Common Cold-URI
TBI treatment
Allergic Rhinitis
Laryngitis
Viral Pharyngitis
Strep Pharyngitis
Shortness of Breath: Possible MI
Plan: p 95, Emergency 33 (Chest Pain)
Hyperventilation: Plan: p.704 Mental Health 3
Shortness of Breath: Possible Heart Failure
Shortness of Breath: Poss. Pulmonary Embolism
Mild Allergic Reaction
Fungal Skin Infection
Acne
Dandruff
Warts
Insect Bite or Sting
Dermatitis, Acute or Chronic
Impetigo
Chickenpox/Varicella
Lice
Scabies
Bladder Infection (UTI)
Laceration, Abrasion, or Puncture Wound
January 2016

Office of Health Services
RN PCMO Standing Orders:
Wounds 3, p. 466
Respiratory 4, p.298
PEACE CORPS
TECHNICAL GUIDELINE
Intestinal Worms #820
Malaria # 845
Typhoid Fever #825
Schistosomiasis #850
Filariasis
Heat Related Illness #880
Altitude Related Illness #885
Anaphylaxis #615
Endocarditis Prophylaxis #630
Skin Infections, Common #635
Respiratory Infections #640
Tuberculosis #645
Hepatitis #650
Emergency Post Coital
Contraception (Plan B) #700 page
13
STD/HIV Prevention: Post
Exposure Protocol #710;
Attachments C, D, E
Male Genitourinary Infections #770
Pain Management #610
Attachment A
Acute Diarrhea #810
Immunization #300
Sexual Assault #540
___________________________/DATE
Geri Brady Kelly, RN/ Competency Verification
GBK/ Initials
*Clinical Competence may be demonstrated by such activities as: Patient encounter chart review, telephone traffic
review, onsite clinical evaluation, and continuing education. Verifying this competency may be completed by QI Staff,
Field Staff, Program and Training Instructor or Supervising Physician.
TG 605 Attachment A
United States Peace Corps
1111 20th St NW
Washington, DC 20526
Country:
Foreign Body Under Skin, i.e. splinter
Sinus Infection
STANDING ORDER
Treatment of Intestinal Worms
Malaria Prevention and Diagnosis (refer to
Prescribing Provider for treatment plan)
Typhoid Prevention and Diagnosis (refer to
Prescribing Provider for treatment plan)
Schistosomiasis Diagnosis and Treatment
Filariasis Prevention, Diagnosis and Treatment
Heat Related Illness Prevention,
Diagnosis and Treatment
Altitude Related Illness Prevention,
Diagnosis and Treatment
Anaphylaxis: Diagnosis and Treatment
(also CHAM E-21)
Prophylaxis: Endocarditis
Common Skin Infections: Diagnosis and Treatment
Respiratory Infections: Diagnosis and Treatment
TB: Screening, Classification, Diagnosis and
Treatment
(also CHAM Respiratory 21)
Hepatitis: Screening, Classification,
Diagnosis and Treatment
Plan B (also CHAM Birth Control 6)
Post Exposure Assessment and Prophylaxis
Diagnosis and Treatment
Pain Management Acetaminophen & NSAIDS
Management of acute diarrheal syndromes due to
infectious causes
Use and administration of Vaccines
Clinical Management of Rape and Major Sexual
Assault
____________________________/DATE
Barry G. Simon, MD/ Supervising Physician
BGS/ Initials
January 2016