Get the free NALOXONE INTAKE FORM Overdose Awareness Day and ... - dvs ohio

NALOXONE INTAKE FORM Overdose Awareness Day and Recovery Month Events Only utilize this form annually for events on August 1 through September 30FOR OFFICE USE ONLY Form identification number: ___

How to fill out naloxone intake form overdose

How to fill out naloxone intake form overdose

1. Obtain naloxone intake form from a healthcare provider or pharmacy.
2. Fill out the necessary personal information, such as name, date of birth, and contact information.
3. Provide information about any allergies or medical conditions that may be relevant to the use of naloxone.
4. Indicate any current medications being taken, especially those that may interact with naloxone.
5. Sign and date the form indicating consent to receive naloxone and understanding of its use.
6. Return the completed form to the healthcare provider or pharmacy where you obtained it.

Who needs naloxone intake form overdose?

1. Individuals who are at risk of experiencing or witnessing an opioid overdose may need to fill out a naloxone intake form.
2. This can include individuals with a history of substance use disorder, individuals prescribed opioid medications, or those who are part of a community where opioid overdoses are prevalent.

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What is naloxone intake form overdose?

Naloxone intake form overdose is a document used to record the administration of naloxone in cases of opioid overdose.

Who is required to file naloxone intake form overdose?

Healthcare professionals, first responders, and individuals who administer naloxone in cases of opioid overdose are required to file naloxone intake form overdose.

How to fill out naloxone intake form overdose?

The naloxone intake form overdose should be filled out with details of the individual receiving naloxone, the person administering it, the date and time of administration, and any other relevant information.

What is the purpose of naloxone intake form overdose?

The purpose of naloxone intake form overdose is to document the use of naloxone in opioid overdose situations for monitoring and research purposes.

What information must be reported on naloxone intake form overdose?

Information such as the individual's name, age, gender, contact information, details of the overdose, symptoms observed, dose of naloxone administered, and any follow-up instructions must be reported on naloxone intake form overdose.