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  • Deployment Reporting Form - Pa Draft 1-2015pdf

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Naloxone Administration Pennsylvania Please return completed forms to the Philadelphia/Camden HIDTA office Email: pchidta.org Fax: 2158633495 AGENCY NAME TIME OF OVERDOSE DATE OF OVERDOSE AGENCY.

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How to fill out the Deployment Reporting Form - PA Draft 1-2015pdf online

Filling out the Deployment Reporting Form - PA Draft 1-2015pdf online can seem daunting, but with the right guidance, it can be straightforward and efficient. This guide will walk you through each section of the form clearly and concisely.

Follow the steps to successfully complete the form online.

  1. Press the ‘Get Form’ button to access the Deployment Reporting Form - PA Draft 1-2015pdf and open it in your online editor.
  2. Begin filling out the form by entering the name of your agency in the designated field. Make sure to provide the official name as it appears in your records.
  3. Record the time and date of the overdose incident. Select either AM or PM as appropriate.
  4. Enter the agency incident number to help in tracking the report. This number should be unique for each incident.
  5. Input the age and gender of the victim in the provided fields. Make selections based on the available options.
  6. Fill in the zip code and county where the overdose occurred. This information is critical for local recordkeeping.
  7. In the next section, indicate the city where the overdose took place and the city of the victim's residence.
  8. Select the race/ethnicity of the victim from the given options, marking all applicable categories.
  9. Check all signs of overdose present at the scene. You can specify additional signs in the provided field.
  10. Indicate the suspected drugs involved in the overdose by checking all that apply. Provide details about other drugs where necessary.
  11. Document any evidence secured related to the incident by filling out the relevant fields for drugs and paraphernalia.
  12. If naloxone was administered, record details, including if someone else administered it and their relationship to the victim.
  13. Note the number of doses used and the time it took for the naloxone to take effect.
  14. Describe the person's response to naloxone using the provided options.
  15. Indicate whether the person survived and check any post-naloxone symptoms they experienced.
  16. Detail any additional actions taken during the incident using the checkboxes.
  17. Enter the naloxone lot number and expiration date in the designated fields.
  18. Provide any notes or comments you feel pertinent to the incident in the comments section.
  19. Include the officer's name and badge number, and ensure the officer signs and dates the form where indicated.
  20. Lastly, input the contact phone number before proceeding to save, download, print, or share the completed form.

Take the next step and complete your Deployment Reporting Form online today for efficient documentation.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232