Get the free Quitline Referral Form - health qld gov
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Referral Form Information collected by the Quit line will be treated confidentially and will not be released to other entities unless required by law. Client/patient details Sex: Given names: Postal
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What is quitline referral form?
The quitline referral form is a document used to refer individuals who want to quit smoking or using tobacco products to a quitline service for assistance and support.
Who is required to file quitline referral form?
Healthcare providers, counselors, or any authorized personnel who come in contact with individuals looking to quit smoking or using tobacco products are required to file the quitline referral form.
How to fill out quitline referral form?
To fill out the quitline referral form, you need to provide the necessary personal information of the individual seeking assistance, their smoking or tobacco usage history, any existing medical conditions, and contact details. Additionally, you may need to document any relevant counseling or healthcare services provided.
What is the purpose of quitline referral form?
The purpose of the quitline referral form is to ensure individuals looking to quit smoking or using tobacco products are connected to the appropriate quitline service for support, guidance, and resources to help them in their quitting journey.
What information must be reported on quitline referral form?
The quitline referral form typically requires information such as the individual's full name, contact details, smoking or tobacco usage history, any relevant medical conditions, previous quit attempts, and any counseling or healthcare services provided.
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