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Overdose Field Report * Please do not forget to upload this information online * mohopeproject.org/ODreport Date: Zip Code of Overdose Event: Individuals city and state of primary residence: Incident

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How to fill out overdose field report

01

Start by gathering all the necessary information about the overdose incident, such as the date, time, and location.

02

Write down the personal details of the person who experienced the overdose, including their name, age, and contact information.

03

Document the substances involved in the overdose, their quantity, and any other relevant information about their composition.

04

Describe the signs and symptoms observed during the overdose, such as unconsciousness, difficulty breathing, or abnormal behavior.

05

Provide a detailed account of the actions taken to respond to the overdose, including administering first aid, contacting emergency services, or administering naloxone.

06

Note any additional information that may be relevant to understanding the circumstances surrounding the overdose, such as the presence of drug paraphernalia or witnesses.

07

Review the filled-out report for accuracy and completeness before submitting it to the appropriate authorities or healthcare professionals.

Who needs overdose field report?

01

Overdose field reports are needed by healthcare professionals, emergency responders, law enforcement agencies, and organizations involved in public health and drug overdose prevention.

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What is overdose field report?

The overdose field report is a form used to document information about overdose incidents.

Who is required to file overdose field report?

Medical professionals and emergency responders are required to file overdose field reports.

How to fill out overdose field report?

To fill out an overdose field report, one must document information such as date, time, location, substances involved, and medical interventions performed.

What is the purpose of overdose field report?

The purpose of the overdose field report is to track and analyze overdose incidents in order to improve response and prevention efforts.

What information must be reported on overdose field report?

Information such as date, time, location, substances involved, medical interventions performed, and patient demographics must be reported on an overdose field report.

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