Get the free Smoking cessation patient referral form - gp westernsussexhospitals nhs

PATIENT REFERRAL FORM FOR THE SMOKING CESSATION SERVICE Patient Details Name Address Postcode Telephone No. G. P Date of birth.

How to fill out smoking cessation patient referral

How to fill out a smoking cessation patient referral:

1. Begin by gathering the necessary information about the patient. This may include their name, contact information, medical history, and smoking habits.
2. Consult the smoking cessation referral form provided by your healthcare facility or organization. Fill out the required fields, such as the reason for referral and any relevant medical conditions or concerns.
3. Clearly state the patient's smoking history, including the number of cigarettes smoked per day, the duration of smoking, and any previous attempts at quitting.
4. Provide any additional information that may be pertinent to the referral, such as the patient's motivation to quit, any existing support systems, or any challenges they may face during the quitting process.
5. Consider including any relevant medical test results or images that may support the referral, such as lung function tests or chest X-rays.
6. If there are specific preferences for the smoking cessation program or intervention, indicate them clearly in the referral form. This may include preferences for medication, counseling, or behavioral therapy.
7. Ensure that the referral form is signed and dated, and that any necessary documentation or attachments are included before submitting it to the appropriate healthcare professional or department.

Who needs smoking cessation patient referral:

1. Individuals who are regular smokers and wish to quit or need assistance in quitting may benefit from a smoking cessation patient referral.
2. Patients who have a high risk of smoking-related health complications, such as those with existing respiratory conditions (e.g., asthma, chronic obstructive pulmonary disease) or cardiovascular disease, may be appropriate candidates for a referral.
3. Pregnant women who smoke may also require a smoking cessation patient referral to ensure the health and well-being of themselves and their unborn child.

It is important to consult with healthcare professionals or guidelines specific to your healthcare setting to determine when a smoking cessation patient referral is appropriate.

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What is smoking cessation patient referral?

Smoking cessation patient referral is the process of referring patients who smoke to programs or resources that can help them quit smoking.

Who is required to file smoking cessation patient referral?

Healthcare providers, such as doctors, nurses, and pharmacists, are required to file smoking cessation patient referral.

How to fill out smoking cessation patient referral?

To fill out smoking cessation patient referral, healthcare providers need to gather information about the patient's smoking habits, medical history, and any previous quit attempts.

What is the purpose of smoking cessation patient referral?

The purpose of smoking cessation patient referral is to help patients quit smoking and improve their overall health.

What information must be reported on smoking cessation patient referral?

Information such as patient demographics, smoking history, current tobacco use, readiness to quit, and any relevant medical conditions must be reported on smoking cessation patient referral.