MFR Narcan Administration Form
Reporting MFR Agency *
Your answer
Incident Location *
Your answer
Patient Age *
Your answer
Patient Sex *
ETA of ALS prior to administering Narcan? *
Total amount of Narcan administered by MFR agency *
Known Narcotic use by patient prior to arrival? *
What drug do you think the patient overdosed on ?
Your answer
Was this a Cardiac Arrest *
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