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TobaccoCessationPhysicianAffidavitForm Emoryemployeesandtheirspouseswhoarecoveredunderourmedicalplansandusetobaccoproductswill incuratobaccousagesurcharge. Towaivethissurcharge, thecoveredindividualsmustcertifythattheyhavenotused
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What is tobacco cessation physician affidavit?
The tobacco cessation physician affidavit is a document that certifies that a physician has provided counseling and treatment to help patients quit smoking or using tobacco products.
Who is required to file tobacco cessation physician affidavit?
Physicians who have provided tobacco cessation counseling and treatment to patients are required to file the tobacco cessation physician affidavit.
How to fill out tobacco cessation physician affidavit?
The tobacco cessation physician affidavit can be filled out by providing information about the physician, the patients treated for tobacco cessation, and the counseling and treatment provided.
What is the purpose of tobacco cessation physician affidavit?
The purpose of the tobacco cessation physician affidavit is to document the efforts of physicians in helping patients quit smoking or using tobacco products.
What information must be reported on tobacco cessation physician affidavit?
Physicians must report information about the patients treated for tobacco cessation, the counseling and treatment provided, and the outcomes of the treatment.
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