STN Report - Overdose Reversal
Thank you for taking the time to report an overdose reversal. This is an anonymous report. Please provide the following information for our records. If you would like a replacement Naloxone(Narcan) email us at strongertogethernowie@gmail.com. We publish the monthly number of overdose reversals on our Instagram page.
When did the reversal happen?(best estimate)
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Month
-
Day
Year
Date
How many doses were used?
What type of Naloxone (Narcan) was used?
Spray
Injection
Unknown
In what zip code did the reversal happen?
City or Region of the Overdose
*
Who administered the Naloxone(Narcan)?
*
Do you know what drug(s) were used?
Who administered the Naloxone(Narcan)?
Friend or Peer of the person who overdosed
Family Member of the person who overdosed
Service Provider(Shelter Staff, Social Worker, etc)
IEHR Participant
IEHR Volunteer
Other
Are there any other details you would like us to know or a message you would like to send to the staff?
If you have additional questions or comments, let us know here.
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