By completing this form, I am requesting to enroll my organization as a Project in the Illinois Department of Human Services, Division of Substance Use Prevention and Recovery (IDHS/SUPR) Drug Overdose Prevention Program (DOPP). Enrolling in DOPP authorizes my organization to provide Overdose Education and Naloxone Distribution OEND services in the State of Illinois. Organizations that are enrolled in DOPP will be provided with an account to directly order naloxone (Narcan nasal spray) and an account in the DOPP Portal for reporting data related to the delivery of OEND services. Please note, if you are already enrolled as a DOPP, please go directly to the portal at

IMPORTANT: Your submission is not complete, and will not be approved, until you fill out this form completely including signing and dating on the final page.

Question Title

* 1. How often do you intend to order naloxone by the case (12 two dose boxes) per year?