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Short-acting Opioid Form Fax 18664230945 Pharmacy Dept. Phone 4014278200 This form is to be used by participating physicians and providers to obtain coverage. Please complete the form by providing

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How to fill out getting naloxone in pharmacies

01

Visit your local pharmacy and ask them if they carry naloxone.

02

Fill out a brief form with your personal information.

03

Receive brief training on how to administer naloxone.

04

Pay for the naloxone (cost may vary depending on insurance coverage).

05

Receive the naloxone kit along with instructions on how to use it.

Who needs getting naloxone in pharmacies?

01

Individuals who are at risk of experiencing an opioid overdose, including those who are prescribed opioid medications, people who use illicit opioids, and their family members and loved ones.

02

First responders, healthcare professionals, and community members who may come in contact with individuals at risk of overdose.

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What is getting naloxone in pharmacies?

Getting naloxone in pharmacies involves obtaining the medication naloxone, which is used to reverse the effects of an opioid overdose.

Who is required to file getting naloxone in pharmacies?

Pharmacists or individuals obtaining naloxone from pharmacies are required to file the necessary paperwork for getting naloxone.

How to fill out getting naloxone in pharmacies?

To fill out getting naloxone in pharmacies, individuals must provide their personal information, reason for obtaining naloxone, and any other required details on the designated form or paperwork.

What is the purpose of getting naloxone in pharmacies?

The purpose of getting naloxone in pharmacies is to ensure that individuals have access to this life-saving medication in case of an opioid overdose emergency.

What information must be reported on getting naloxone in pharmacies?

The information reported on getting naloxone in pharmacies may include the name of the individual obtaining naloxone, date of transaction, quantity received, and any other relevant details.

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