Get the free TOBACCO USE CHANGE FORM - University of Georgia - busfin uga

University of Georgia Change of tobacco use Clear form TOBACCO USE CHANGE FORM Employee Name: Employee date of birth: Tobacco Use Certification. A tobacco user is defined as any employee/retiree,

How to fill out tobacco use change form

How to fill out tobacco use change form:

1. Obtain the form: The tobacco use change form can usually be obtained from your health insurance provider or employer. You can request it through their website, call their customer service, or visit their office in person.
2. Provide personal information: Start by filling out the personal information section of the form. This typically includes your name, date of birth, address, contact information, and policy or group number.
3. Indicate current tobacco use status: In this section, you will need to indicate your current tobacco use status. If you are a tobacco user, specify the type of tobacco product you use (cigarettes, cigars, chewing tobacco, etc.) and the frequency of use (daily, occasionally, etc.). If you do not use tobacco, simply mark the appropriate box.
4. Update changes: If you are making any changes to your tobacco use status, mark the appropriate boxes or provide the necessary information. For example, if you have recently quit smoking, indicate the date of quitting or provide details about any tobacco cessation programs you have participated in.
5. Sign and date: Make sure to read through the form carefully, ensuring that all the sections are filled out accurately. Once you have reviewed the information, sign and date the form. This signature confirms that the provided information is true and accurate to the best of your knowledge.

Who needs tobacco use change form:

1. Individuals with health insurance: If you have health insurance, it is likely that your insurance provider requires you to fill out a tobacco use change form to update your tobacco use status. This helps them determine your risk factors and may affect your insurance premiums or eligibility for certain programs or benefits.
2. Employees with tobacco-related benefits: Some employers offer tobacco-related benefits, such as discounted health insurance premiums for non-smokers or participation in tobacco cessation programs. In order to qualify for these benefits, employees may be required to fill out a tobacco use change form to update their status.
3. People applying for insurance coverage: When applying for new insurance coverage, whether it's for health, life, or disability insurance, you may be asked to provide information about your tobacco use. In such cases, a tobacco use change form may be required to update your status from the time of application until the policy is issued.

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What is tobacco use change form?

The tobacco use change form is a document used to report any changes in tobacco use status.

Who is required to file tobacco use change form?

Any individual or organization who has made changes to their tobacco use status is required to file the tobacco use change form.

How to fill out tobacco use change form?

The tobacco use change form can be filled out online or manually by providing accurate information about the changes in tobacco use status.

What is the purpose of tobacco use change form?

The purpose of the tobacco use change form is to update records and ensure compliance with tobacco use regulations.

What information must be reported on tobacco use change form?

The tobacco use change form requires the reporting of changes in tobacco use status, including cessation or increase in tobacco use.