Get the free Project DAWN Naloxone Intake Form Standard Version 3.4
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NALOXONEINTAKEFORM
FOR OFFICE USE ONLY
Form identification number: ___ODD general allocationNumber of kits provided: ___ODD grant (IN20/IN21)Type of kit:Other ___IndividualDistribution setting:How
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How to fill out project dawn naloxone intake
How to fill out project dawn naloxone intake
01
Gather all necessary personal information of the individual requesting naloxone intake.
02
Obtain consent from the individual to participate in the Project Dawn naloxone intake.
03
Provide education on how to properly administer naloxone in case of an overdose.
04
Distribute the naloxone kit to the individual and demonstrate how to use it.
05
Document the intake process and any additional information provided by the individual.
Who needs project dawn naloxone intake?
01
Individuals who are at risk of experiencing an opioid overdose.
02
Family members and friends of individuals who are at risk of opioid overdose.
03
Healthcare professionals who work with patients at risk of opioid overdose.
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What is project dawn naloxone intake?
Project Dawn Naloxone Intake is a program that provides access to the overdose-reversal medication naloxone.
Who is required to file project dawn naloxone intake?
Individuals or organizations who distribute naloxone kits are required to file project dawn naloxone intake reports.
How to fill out project dawn naloxone intake?
Project dawn naloxone intake can be filled out online through the designated reporting portal provided by the program.
What is the purpose of project dawn naloxone intake?
The purpose of project dawn naloxone intake is to track the distribution and use of naloxone kits in order to combat opioid overdoses.
What information must be reported on project dawn naloxone intake?
The information that must be reported on project dawn naloxone intake includes the number of naloxone kits distributed, the date of distribution, and the demographics of the recipients.
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