Naloxone Dispensing and Standing Order Documentation

Documents naloxone dispensing under a standing order, including eligibility, patient education, and dispensing details while minimizing unnecessary PII.

Dispensing Context

• Dispense Date
  Date naloxone was dispensed.
• Dispensing Location
  Location or site where the naloxone was dispensed.
• Standing Order Reference
  Internal standing order, protocol, or authorization reference.
• Dispensed By
  Name and role of the staff member completing the dispense.

Patient Eligibility and Consent

• Patient Type
  Select the dispensing context.
• Eligible Under Standing Order
  Confirm the dispense is authorized under the applicable standing order.
• Patient Name
  Optional. Collect only if needed for your workflow or audit trail.
• Patient Contact Information
  Optional. Use only if follow-up or counseling contact is necessary.
• Consent to Receive Naloxone and Education
  Document consent/disclosure acknowledgment before dispensing.

Product Dispensed

• Product Form
  Select the naloxone formulation dispensed.
• Product Name
  Brand or product name.
• Strength / Concentration
  Document the labeled strength or concentration.
• Quantity Dispensed
  Number of units dispensed.
• Lot Number
  Optional. Collect if required for inventory or recall tracking.
• Expiration Date
  Optional. Use if your workflow tracks product expiration.

Education and Harm Reduction Counseling

• Education Topics Covered
  Select all topics reviewed with the patient.
• Patient Demonstrated Understanding
  Document whether the patient understood the instructions.
• Teach-Back Completed
  Optional. Use if teach-back was performed.
• Additional Counseling Notes
  Document any relevant counseling details, barriers, or follow-up needs.

Attestation and Submission

• Attestation
  Required attestation for documentation integrity.
• Follow-Up Needed
  Indicate whether follow-up is needed.
• Follow-Up Reason
  Explain why follow-up is needed.