Content of patient protocol

A written protocol for a specific patient established pursuant to a collaborative drug therapy management agreement shall include, but need not be limited to, the following: (1) The specific drug or drugs to be managed by the pharmacist; (2) The terms and conditions under which drug therapy may be implemented, modified or discontinued; (3) The conditions and events that the pharmacist is required to report to the physician; (4) The laboratory tests that may be ordered by the pharmacist; and (5) The drugs that may be administered by the pharmacist.