Site Management

Here you will find current versions of our required program forms.

1: Supply Order Form.

To receive naloxone kits and training materials please complete and submit this form.

Orders must be received by 12pm Wednesday or will be carried over into the following week.

Please allow 10 working days for delivery and plan ahead to avoid shortages. Email outreach@towardtheheart.com for queries, follow-ups or changes to orders.

2: Naloxone kit Distribution Record

NEW Distribution Record Posted September 14, 2017. See Update regarding Kit ID phase-out above.

Participating sites are required to complete a distribution record for each kit provided to an individual (whether at risk, or at risk of witnessing an overdose).

Use the multi-record distribution record to record kits distributed by your site and fax to the BCCDC monthly, unless no kits have been distributed.

Patient details such as name, date of birth and PHN are not required by our program. Please refrain from faxing identifiers to the BCCDC.

3: Overdose Response Information Form 

The overdose administration form is included inside every THN kit. The completion of these forms provides valuable information to the BCCDC which helps to inform our program.

Please assist clients with completing this form if a kit has been reported as 'used'. 

Fax all completed forms to: 604-707-2516

Use this form to let us know about any changes to contact information or personnel.

Additional Resources

Additional resources for site staff can be found in our Health Professionals section.

Thank You

The Ministry of Health has released a Letter of Appreciation for the incredible contribution of naloxone trainers across the province!