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MARYLAND TOBACCO OUTLINE FAX REFERRAL FORM Fax Number: 18004833114 FAX SENT DATE: / / Provider Information: CLINIC NAME TO APPEAR IN OUTLINE REPORTS CLINIC ZIP CODE NAME OF PROVIDER MAKING REFERRAL

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How to fill out maryland tobacco quitline

01

Obtain the form from the Maryland Tobacco Quitline website or contact their helpline

02

Provide your personal information such as name, address, and contact details

03

Answer the questionnaire to determine your eligibility

04

Follow the instructions and provide the required information accurately

05

Submit the form through the designated method, either online or by mail

06

Wait for a representative from the Maryland Tobacco Quitline to contact you

Who needs maryland tobacco quitline?

01

Anyone who wants to quit tobacco use in Maryland

02

Individuals who are struggling with quitting on their own

03

People who desire professional help and support in their quit journey

04

Residents of Maryland who are over the legal age for tobacco use

05

Those who are ready to commit to quitting and willing to follow the program

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What is maryland tobacco quitline?

The Maryland Tobacco Quitline is a free telephone counseling service that can help people quit smoking and using tobacco products.

Who is required to file maryland tobacco quitline?

Healthcare providers, organizations, and individuals who provide tobacco cessation services in Maryland are required to report to the Maryland Tobacco Quitline.

How to fill out maryland tobacco quitline?

To fill out the Maryland Tobacco Quitline, providers can call the toll-free number or visit the website to report information about tobacco cessation services provided.

What is the purpose of maryland tobacco quitline?

The purpose of the Maryland Tobacco Quitline is to help individuals quit smoking and using tobacco products by providing support, counseling, and resources.

What information must be reported on maryland tobacco quitline?

Providers must report data on the number of individuals served for tobacco cessation services, demographics, type of services provided, and outcomes.

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