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Naloxone Treatment Quarterly Reporting Form Department of Criminal Justice Services Byrne/JAG Naloxone for Law Enforcement Granular Enforcement Agency: CJS Grant Number: Grant Reporting Period: Naloxone
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How to fill out naloxone treatment quarterly reporting

01
Obtain the naloxone treatment quarterly reporting form from your healthcare provider or the organization responsible for monitoring naloxone treatment.
02
Fill out your personal information, including your name, date of birth, contact information, and any other requested details.
03
Provide information about the healthcare provider or organization providing your naloxone treatment, including their name, address, and contact information.
04
Indicate the dates of your naloxone treatment during the specified quarter.
05
Provide details about the dose and frequency of naloxone treatment received during each session.
06
If applicable, report any side effects or adverse reactions experienced during the naloxone treatment.
07
Sign and date the form to certify the accuracy of the information provided.
08
Submit the completed naloxone treatment quarterly reporting form to the appropriate healthcare provider or organization as instructed.

Who needs naloxone treatment quarterly reporting?

01
Individuals who are on naloxone treatment for opioid overdose prevention and have been instructed to provide quarterly reports to their healthcare provider or the organization responsible for monitoring their treatment.
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Naloxone treatment quarterly reporting is a process of reporting on the administration of naloxone, a medication used to reverse opioid overdose, on a quarterly basis.
Healthcare facilities, first responders, and organizations that provide naloxone treatment are required to file naloxone treatment quarterly reporting.
Naloxone treatment quarterly reporting can be filled out online through a designated platform provided by the governing authority.
The purpose of naloxone treatment quarterly reporting is to monitor and track the use of naloxone in combating opioid overdoses and to ensure accountability and transparency in its administration.
Information such as the number of naloxone administrations, demographics of recipients, location of administration, and any adverse reactions must be reported on naloxone treatment quarterly reporting.
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