Community Narcan Use Form

Please use this form whenever naloxone is used!

To submit electronically, you must first DOWNLOAD THIS FORM to your device

All information is COMPLETELY CONFIDENTIAL! The data is only used to improve the Opioid Overdose Prevention Program.

Once you submit the form (electronically or by dropping it off or mailing it to Islip Terrace Fire Department Headquarters),

make sure you request a replacement naloxone kit!