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NALOXONE INTAKE FORM (standard) FOR OFFICE USE ONLY Distribution Setting: Community Access Point Online Mail order Corrections×Court System Pharmacy ED×Urgent Care ART FHC×only Clinic School×University

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How to fill out odhohiogov wps wcmnaloxone intake

01

To fill out the odhohiogov wps wcmnaloxone intake form, follow these steps:

02

Visit the website odh.ohio.gov

03

Locate the 'WPS WCMNaloxone Intake Form' section

04

Click on the form to open it

05

Review the instructions and requirements mentioned on the form

06

Enter your personal information accurately, such as name, address, contact details

07

Provide any requested medical information related to opioid use

08

Answer all questions honestly and to the best of your knowledge

09

If applicable, include any additional information or comments in the designated section

10

Double-check all the entered information for accuracy

11

Sign and date the form if required

12

Submit the completed form as instructed, either online or by mail

Who needs odhohiogov wps wcmnaloxone intake?

01

The odhohiogov wps wcmnaloxone intake form is intended for individuals who:

02

- Are seeking access to naloxone (an antidote for opioid overdose)

03

- Want to provide necessary information to participate in the WPS WCMNaloxone program

04

- Have a need for increased access to naloxone for themselves or someone they know

05

- Are residing in Ohio, as this program is specific to the state

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What is odhohiogov wps wcmnaloxone intake?

ODHOhioGov WPS WCM Naloxone Intake is a form used to report naloxone distribution activities in the state of Ohio.

Who is required to file odhohiogov wps wcmnaloxone intake?

All entities distributing naloxone in Ohio are required to file the ODHOhioGov WPS WCM Naloxone Intake form.

How to fill out odhohiogov wps wcmnaloxone intake?

The ODHOhioGov WPS WCM Naloxone Intake form can be filled out online on the Ohio Department of Health's website.

What is the purpose of odhohiogov wps wcmnaloxone intake?

The purpose of the ODHOhioGov WPS WCM Naloxone Intake form is to track the distribution of naloxone in the state and monitor its availability.

What information must be reported on odhohiogov wps wcmnaloxone intake?

The ODHOhioGov WPS WCM Naloxone Intake form requires information such as the quantity of naloxone distributed, the distribution locations, and the recipients of the naloxone.

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