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Naloxone Reporting Form

Naloxone Program Reporting

Contact Person(Required)

Key Outcomes for the Month

Number of Individuals

Number of individuals who reported administering or receiving Naloxone, including how many doses were given per administration

Additional Information

Please provide any additional information that you feel is pertinent for the ministry to know about, including anecdotal trends and reports:

If you have any questions or concerns, please contact Harm Reduction at 613-345-5685 or 1-800-660-5853.