I do home care and our process is pretty simple. The physician has pre-wriiten protocols for new admits as well as standing orders for existing patients. The nurse simply co-signs the order and we fax it to the pharmacy and receive in 4 hours or less. The Dr then sends the triplicate to the pharmacy within 24 hours. It requires that the Physician trusts the clinical judgement of the nurse. but it really does work for our situation.