By submitting the online application form, the entity:

1. Certifies that the contact and location information provided is correct.
2. Will ensure that any of its affiliates or subcontractors apply for their own standing order.
3. Agrees to allow the California Department of Public Health to contact the entity using the information provided on the application form.
4. Agrees to allow the California Department of Public Health to use the information provided on the application form to track the use of the standing order and conduct other public health and epidemiological surveillance activities.
5. Acknowledges that the standing order cannot be used to sell albuterol.
6. Agrees to ensure that entities and individuals receiving and administering albuterol receive initial and annual refresher training, in accordance with the Education Code section 49414.7.
7. Agrees to maintain and report to California Department of Public Health, within three business days of usage, information regarding the number of doses of albuterol administered under this standing order.
8. Agrees to re-register for the standing order if there is a change in the information required on this form.
9. Agrees in accordance with Education Code section 49414.7(g)(4), that the authorizing physician and surgeon shall not be subject to professional review, be liable in civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeon's issuance of a prescription or order constitutes gross negligence or willful or malicious conduct.
10. Agrees to maintain a copy of the standing order, which will include these terms and conditions.