2017 Naloxone Administration Survey

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NALOXONE ADMINISTRATION SURVEY

This survey is intended for use by law enforcement, fire and EMS to record administrations of naloxone (Narcan) used for suspected opioid drug/medication overdose.

This survey and the submitted cases are Professional Standards Review Organization (PSRO) materials of the Medical Control Authority with statutory jurisdiction, in cooperation with the West Michigan Regional Medical Control Consortium, PSRO subcommittee. All submitted case related information is designated as quality improvement data per MCL 333.20919 (1)(g) and is protected from disclosure, pursuant to the provisions of Michigan law including: MCL 330.1143a, MCL 330.1748, MCL 331.531, MCL 331.533, MCL 331.20175, MCL 333.21513, MCL 333.21515 and all other applicable laws. Unauthorized use, disclosure or duplication is absolutely prohibited