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Get Naloxone - Mass.gov - Mass
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How to fill out the Naloxone - Mass.Gov - Mass online
Filling out the Naloxone application form for municipalities and non-municipal public agencies is essential to authorize employees to administer naloxone. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to complete the application process.
- Click the ‘Get Form’ button to obtain the application form and launch it for editing.
- Indicate the application type by selecting one of the available options: 'New', 'Renewal', or 'Amended Information'.
- Fill in the 'Applicant' section with the name of the municipality or public agency.
- Add the 'Applicant Federal Tax ID No.' as required by Massachusetts law.
- Review the certification statement to ensure accuracy. The Medical Director must certify that the provided information is true and complies with Massachusetts laws.
- Attach copies of the Medical Director’s Board of Registration in Medicine License and the Massachusetts Controlled Substances Registration (MCSR).
- Once submitted, monitor for any communication regarding the status of the application to avoid delays.
Start filling out your Naloxone application online today to ensure timely processing.
Cost of naloxone: Depending on the specific form of naloxone used by the department, the cost of a single naloxone rescue kit ranges from approximately $22-$60 for intranasal kits.
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