Get the free S.C. Tobacco Quitline Fax Referral Form

SOUTH CAROLINA TOBACCO OUTLINE SOUTH CAROLINA TOBACCO OUTLINE Provider Fax Referral Form www.scdhec.gov/quitforkeeps Provider Fax Referral Form www.scdhec.gov/quitforkeeps www.scdhec.gov/administration/library/d-1042.pdf

How to fill out sc tobacco quitline fax

How to fill out the SC Tobacco Quitline fax:

1. Gather the necessary information: Before filling out the fax, you'll need to collect the required information, including your personal details, contact information, and any relevant tobacco use history.
2. Use the appropriate fax cover sheet: It's crucial to use the correct fax cover sheet provided by the SC Tobacco Quitline. This sheet ensures that your fax is properly received and processed by the Quitline team.
3. Fill out your personal information: Start by filling out your personal details, such as your full name, date of birth, gender, address, and phone number. Ensure all the information provided is accurate and up to date.
4. Provide tobacco use details: The next step involves sharing important information about your tobacco use. This may include the type of tobacco used (cigarettes, smokeless, etc.), the number of years you've been using tobacco, the average number of cigarettes smoked per day, and any previous quit attempts.
5. Share your quit goals and preferences: Let the Quitline know your goals for quitting tobacco and any specific preferences you may have. This could include your preferred quit date, the method of support you're seeking (phone counseling, medication, etc.), and any additional notes or comments you'd like to include.
6. Complete any additional sections: If the SC Tobacco Quitline fax includes any additional sections or questions, make sure to fill them out accurately and completely. These sections may be related to medications, medical history, or other relevant information that can support your quit journey.

Who needs the SC Tobacco Quitline fax?

1. Smokers and tobacco users in South Carolina: The SC Tobacco Quitline fax is designed for individuals who are looking for support and assistance in quitting tobacco use. Whether you smoke cigarettes, use smokeless tobacco, or any other form of tobacco, the Quitline is available to help.
2. Those interested in quitting tobacco: If you're motivated to quit tobacco and want guidance, resources, and support throughout your quit journey, the SC Tobacco Quitline can be an invaluable resource. The fax serves as a means to provide the necessary information to connect with the Quitline's services.
3. Individuals seeking professional help and advice: The SC Tobacco Quitline fax is particularly useful for those who prefer professional counseling and evidence-based assistance in quitting tobacco. By submitting the fax, individuals can access personalized counseling, medication support, and other proven methods to increase their chances of successfully quitting.

Note: It's essential to regularly check the SC Tobacco Quitline website or contact their helpline for the most accurate and up-to-date instructions on how to fill out the fax and access their services.

For pdfFiller’s FAQs

What is sc tobacco quitline fax?

The SC Tobacco Quitline Fax is a form used for reporting tobacco cessation services provided by healthcare providers in South Carolina.

Who is required to file sc tobacco quitline fax?

Healthcare providers in South Carolina who offer tobacco cessation services are required to file the SC Tobacco Quitline Fax.

How to fill out sc tobacco quitline fax?

To fill out the SC Tobacco Quitline Fax, healthcare providers must provide detailed information about the tobacco cessation services they have provided to patients.

What is the purpose of sc tobacco quitline fax?

The purpose of the SC Tobacco Quitline Fax is to track and monitor the provision of tobacco cessation services in South Carolina.

What information must be reported on sc tobacco quitline fax?

Healthcare providers must report information such as patient demographics, types of tobacco cessation services provided, and outcomes of the services on the SC Tobacco Quitline Fax.

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