Pharmacist Naloxone Prescription Program Reporting Form
Gives a sample naloxone prescription program reporting form to be entered into the patient record or chart or given to the primary care provider.
This collection of tools and resources is for providers, staff, and patients who offer or use services to address substance use, and other interested stakeholders. This collection was originally established following an environmental scan on implementing medication-assisted treatment (MAT) for opioid use disorder (OUD) in rural primary care. (See PDFs of Volume 1 [PDF 0.69 MB] and Volume 2 [PDF 1.28 MB] of that scan). Items have been continuously added to this collection since then, and the collection has expanded to cover substance use more broadly, rather than just MAT for OUD.
Gives a sample naloxone prescription program reporting form to be entered into the patient record or chart or given to the primary care provider.
Gives a sample informed consent form that can be used by pharmacists dispensing naloxone rescue kits.
Describes Virginia's Prescription Monitoring Program, including benefits, user testimonials, an informational brochure, and program milestones. Features statistical data about use of the program and prescription drugs, changes in regulations for registered system users, and feature articles for patients.
Presents an overview of PDMPs for prescribers.