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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST FORMOpioid Overdose Agents Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain
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How to fill out opioid overdose agents

01
Make sure to have the necessary opioid overdose agents on hand.
02
Educate yourself on the proper administration of the opioid overdose agents.
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When administering the agents, follow the recommended dosage guidelines.
04
If someone is experiencing an opioid overdose, call emergency services immediately.
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Administer the opioid overdose agent according to the instructions provided.
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Monitor the individual for any signs of improvement or worsening.
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Stay with the individual until medical professionals arrive.

Who needs opioid overdose agents?

01
Individuals who are at a high risk of opioid overdose, such as those with a history of opioid abuse or addiction.
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People who are prescribed opioids for pain management, especially those on high doses or long-term opioid therapy.
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Caregivers or family members of individuals who may be at risk of opioid overdose.
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First responders, healthcare professionals, and emergency medical personnel who may come across individuals experiencing opioid overdose.
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Community organizations and harm reduction programs that aim to prevent opioid overdoses.
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Opioid overdose agents are medications specifically designed to reverse the effects of opioid overdose, with naloxone being the most common example.
Healthcare providers, emergency medical services, and organizations that distribute opioid overdose agents are typically required to file and report their use and distribution.
To fill out opioid overdose agents, one must follow the specific reporting guidelines set by the local health department or governing body, which usually includes patient information, dosage administered, and the outcome.
The purpose of opioid overdose agents is to provide a rapid response to opioid overdoses, restoring normal breathing and consciousness to individuals who have overdosed.
Information that must be reported includes the date and time of administration, the identity of the person administered, the dosage given, the circumstances of the overdose, and any follow-up actions taken.
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