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Illinois Department of Human Services
James T. Dimas, Secretary
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Drug Overdose Prevention Program Forms

Helping Families. Supporting Communities. Empowering Individuals.
  • IL444-2051 (Nov-16) - Drug Overdose Prevention Program Enrollment Form (pdf)
  • IL444-2052 (Nov-16) - Standing Order to Dispense and Administer Naloxone (pdf)
  • IL444-2053 (Nov-16) - Overdose Reversal and Naloxone Administration Reporting Form (pdf)
  • Drug Overdose Prevention Program Guidelines for Implementation (Nov-16)(pdf)

Related Links

  • Drug Overdose Prevention Program Forms
  • Educational Resources – Overdose Prevention Materials
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