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MD HHS Naloxone Request Formic the Submit Form button does not work, please email the request form to MDHHSNalxneRqst@michigan.gov to ensure the form is received. Submit FormNaloxone distributed through
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How to fill out mdhhs ems naloxone request
How to fill out mdhhs ems naloxone request
01
Access the MDHHS EMS Naloxone Request form
02
Fill in all required personal and agency information
03
Indicate the quantity of naloxone requested
04
Provide justification for the amount requested
05
Submit the completed form to MDHHS for review and approval
Who needs mdhhs ems naloxone request?
01
EMS agencies and first responders who administer naloxone to individuals experiencing opioid overdose
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What is mdhhs ems naloxone request?
The MDHHS EMS naloxone request is a form used to request naloxone from the Michigan Department of Health and Human Services for use in emergency medical situations involving opioid overdoses.
Who is required to file mdhhs ems naloxone request?
EMS agencies and first response agencies are required to file the MDHHS EMS naloxone request.
How to fill out mdhhs ems naloxone request?
To fill out the MDHHS EMS naloxone request, agencies must provide their information, the number of doses requested, and justification for the request.
What is the purpose of mdhhs ems naloxone request?
The purpose of the MDHHS EMS naloxone request is to ensure that EMS agencies and first response agencies have an adequate supply of naloxone to respond to opioid overdoses.
What information must be reported on mdhhs ems naloxone request?
The information that must be reported on the MDHHS EMS naloxone request includes agency information, number of doses requested, and justification for the request.
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