New York State Department of Health OPIOID OVERDOSE EDUCATIONAL MATERIALS ORDER FORM Directions: 
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Please circle only one (1) quantity per publication. Complete the address label on the next page. Be sure to print clearly. ALL orders must include a street mailing address. Bulk order cannot be delivered to Post Office boxes. Email order and attach label, send to: [email protected] ; or Mail orders to: New York State Department of Health Distribution Center, P.O. Box 343, Guilderland, NY 12084. Title See An Overdose? Call 911 Immediately! This palm card explains how to recognize an opioid overdose and what life‐saving steps to take when you witness one. It highlights New York State’s “911 Good Samaritan” law, which protects people from prosecution for drug or alcohol possession if they seek help for an overdose (palm card). 12/12. See An Overdose? Call 911 Immediately! Poster version contains all of the information described in the palm card above (poster). 12/12. Language Code # English 0226 Quantity (circle one) 25 50 100 Spanish 0227 25 50 100 English 0230 10 25 50 Spanish 0231 10 25 50 English 0266 25 50 100 Spanish 0267 25 50 100 Stop Prescription Pain Medication Misuse. This palm card warns about the dangers of misusing prescription pain medications. It encourages readers to keep medications in a place at home where teens and other cannot access them (palm card). 3/12. Page 1 of 2 August 2016 Community Opioid Overdose Training Materials For Opioid Overdose Registered Programs ONLY English 0162 How to Use Nasal Naloxone for Opioid Overdose This booklet provides step‐by‐step instructions Spanish 0163 and illustrations on how to use nasal naloxone. It is placed in the training kits that participants receive after completing community opioid overdose trainings and cannot be ordered separately (booklet). 6/15. English 0182 How to Use Injection Naloxone for Opioid Overdose This booklet provides step‐by‐step instructions and illustrations on how to use injection naloxone. Spanish 0183 It is placed in the training kits that participants receive after community opioid overdose trainings and cannot be ordered separately (booklet). 6/15. English 9808 ‘BLUE’ Certificate of Completion cards [only] Upon completing a Community Opioid Overdose training, each participant receives a certificate of completion confirming they have successfully completed the opioid overdose training delivered by a registered opioid overdose program. 25 50 100 25 50 100 25 50 100 25 50 100 25 50 100 500 Name Organization (if applicable) Street address City Phone Email address Delivery: 
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State Zip code Please allow 1‐2 weeks for delivery. Orders cannot be picked up at the Distribution Center. Bulk orders cannot be delivered to Post Office boxes. Be sure to include a street address on the mailing label below. Address Label (please print or type): No PO BOX addresses: Page 2 of 2 August 2016