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NEW MEXICO PHARMACIST NALOXONE PRESCRIPTION PROGRAM REPORTING FORM I. PHARMACY INFORMATION___ Pharmacy Name _ _ _ _ (first letter of pharmacy name, first two letters of city located) Patient ID: __

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How to fill out please use form naloxone

01

Step 1: Obtain a Naloxone kit from a pharmacy, community health center, or harm reduction organization.

02

Step 2: Locate the nozzle of the naloxone vial.

03

Step 3: Remove the cap from the vial.

04

Step 4: Place the nozzle into one nostril of the person who has overdosed.

05

Step 5: Press down on the plunger to administer the naloxone into the nostril.

06

Step 6: If the person does not respond after 2-3 minutes, administer a second dose in the other nostril.

Who needs please use form naloxone?

01

Anyone who is at risk of experiencing an opioid overdose, such as individuals who use opioids recreationally, have a history of opioid dependence, or are prescribed high doses of opioids for pain management.

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What is please use form naloxone?

Please use form naloxone is a form used to request naloxone, a medication used to reverse opioid overdoses.

Who is required to file please use form naloxone?

Healthcare providers or organizations who need to obtain naloxone are required to file please use form naloxone.

How to fill out please use form naloxone?

Please use form naloxone can be filled out by providing the necessary information about the healthcare provider or organization requesting naloxone.

What is the purpose of please use form naloxone?

The purpose of please use form naloxone is to ensure that naloxone is distributed safely and effectively to those who need it to prevent opioid overdoses.

What information must be reported on please use form naloxone?

Information such as the healthcare provider or organization's contact details, the quantity of naloxone needed, and the purpose of use must be reported on please use form naloxone.

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