Office of Emergency Medical Services

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Medication Administration Report

The form listed below is to report the use of BLS Naloxone (Narcan®). This form is mandatory for the use of BLS Naloxone (Narcan®) and shall be completed within 24 hours of administration of the medication. Providers shall also complete a patient care report for each patient encounter.

Please complete the entire form and hit the submit button (You are not able to save the form and return later). You will receive a confirmation number once you have completed and submitted the form. Please save this number for your records.

To Access the Medication Administration Report, please click on this link: CLICK HERE


Emergency Medical Services Payments

Submit Payments