Patient Overdose Emergency Report Form

When every second counts during a suspected overdose, addiction treatment facilities need a fast, thorough way to document the incident and response. This Patient Overdose Emergency Report Form template provides a structured workflow for documenting critical details including patient information, overdose symptoms, Narcan (naloxone) administration, emergency medical services (EMS) coordination, and medical director consultation.

Designed specifically for addiction treatment centers, rehabilitation facilities, behavioral health programs, detox centers, and residential treatment programs, this form ensures staff can quickly capture all essential information during a crisis while meeting regulatory compliance and clinical documentation standards.

The template guides your team through documenting the discovery of the incident, observed symptoms and vital signs, immediate interventions including Narcan administration details (dosage, route, time, and response), EMS notification and transport information, and medical director or on-call physician consultation. Conditional logic reveals relevant sections based on the specific circumstances, ensuring staff only see fields that apply to the situation.

This form works seamlessly with Stepper to automate your post-incident workflow—automatically notify leadership, trigger incident review processes, update electronic health records, alert quality assurance teams, and ensure follow-up care coordination. You can also integrate with Papersign for secure documentation signatures from medical directors, staff witnesses, and reviewing clinicians.

Built with SOC 2 Type II compliance and designed for healthcare operations, Paperform gives addiction treatment facilities a professional, HIPAA-aware solution for managing one of the most critical aspects of patient safety. Start with this template and customize it to match your facility's specific protocols and state requirements.