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10047 Main Street Suite 103 Bellevue, WA 98004 P 425.463.9883 F 425.968.4631 SMOKING RISK CONSENT FORM Patient: Age: I am not a smoker; I quit months or years ago. I currently smoke a day. Patient:
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How to fill out newvue smoking risk consent

Who needs newvue smoking risk consent?
01
Anyone who is a smoker or uses tobacco products and wishes to participate in the newvue program.
02
Individuals who have been diagnosed with or are at risk of developing smoking-related diseases.
03
Participants who are interested in receiving information and resources to help them quit smoking.
How to fill out newvue smoking risk consent:
01
Begin by reading through the consent form carefully and make sure you understand all the information provided.
02
Fill in your personal information, including your name, address, contact details, and date of birth.
03
Indicate your smoking status by selecting the appropriate option: smoker, non-smoker, or former smoker.
04
Provide any relevant medical history or conditions related to smoking. This may include past diagnoses, current medications, or any known risk factors.
05
Acknowledge your understanding of the risks associated with smoking and the potential benefits of participating in the newvue program.
06
Sign and date the consent form.
07
Return the completed form to the designated person or entity as instructed.
Remember, filling out the newvue smoking risk consent form is essential for participating in the program and accessing the resources and support available to help you quit smoking. Please ensure that all the information you provide is accurate and up-to-date for the most effective assistance.
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What is newvue smoking risk consent?
Newvue smoking risk consent is a form that must be completed by individuals who participate in smoking activities at the company premises.
Who is required to file newvue smoking risk consent?
All employees, visitors, or contractors who smoke on company premises are required to file newvue smoking risk consent.
How to fill out newvue smoking risk consent?
Newvue smoking risk consent can be filled out by providing personal information, acknowledging the risks of smoking, and signing the form.
What is the purpose of newvue smoking risk consent?
The purpose of newvue smoking risk consent is to make individuals aware of the risks associated with smoking on company premises and to ensure compliance with relevant regulations.
What information must be reported on newvue smoking risk consent?
Personal information, acknowledgment of smoking risks, and signature are the information that must be reported on newvue smoking risk consent.
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