MATTERS Network- EMS Naloxone
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EMS Agency *
BASIC DEMOGRAPHICS
Patient Age *
Patient Ethnicity *
Patient Gender *
EVENT INFORMATION
ZIP code of occurrence *
Date of event *
MM
/
DD
/
YYYY
Was Naloxone Given? *
Patient Transported *
I attest that I provided the patient/family with a leave behind naloxone kit and instructions *
Required
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