Naloxone Dispensing Entities affirm that they will:

  1. Report/Register with the appropriate program
  2. Update registration as needed to reflect current data
  3. Contact IDPH should the entity no longer be able to provide naloxone (DPH.Opioids@illinois.gov).
  4. Participate in approved training and provide training for those individuals to whom you provide naloxone.

    For Pharmacists this may include:
    1. Any IDHS approved training modules (previously approved modules include Walgreens, CVS, Albertsons, Midwestern University, and IPHA)
    OR
    For Overdose Education and Naloxone Distribution Programs this may include program training materials in compliance with IDHS' Drug Overdose Prevention Program guidelines. Training materials may be found at this link: https://www.dhs.state.il.us/page.aspx?item=116652
  5. Required information to access Naloxone Standing Order
    1. Entity type: *
    2. Entity Name: *
    3. Counties served: *
      (To select multiple counties, please press Ctrl key and click a county at the same time.)
    4. Address 1: *
    5. Address 2:
    6. City: *
    7. State: *
    8. Zip: *
    9. Website:
    10. Contact name (First, Last): *
    11. Phone (xxx-xxx-xxxx): *
    12. Fax: *
    13. Email: *
    14. Display on map (Yes/No): *
*Required