Get the free Tobacco Cessation: Quitline Fax Referral Form (NC DHHS) - communitycarenc

QuitlineNC FAX REFERRAL FORM Fax completed form to: 1-800-483-3114 Referring Organization Information: Date Fax Sent: Organization Name: / / County (Hospital Clinic) In order to receive a Participant

How to fill out tobacco cessation quitline fax

How to fill out tobacco cessation quitline fax:

1. Start by gathering all the necessary information, such as your personal details, contact information, and any relevant medical history.
2. Make sure to have the necessary paperwork or forms provided by the tobacco cessation quitline. These forms may require you to provide information about your current tobacco usage, previous attempts to quit, and any medications or treatments you are currently using.
3. Carefully read through the instructions on the form, ensuring that you understand each section and what is required of you.
4. Begin filling out the form section by section, providing accurate and truthful information. Some sections may require you to provide specific dates, quantities, or other details related to your tobacco use.
5. Double-check all the information you have entered to ensure it is correct and legible. This will help prevent any delays or errors in processing your request.
6. Attach any supporting documents, such as medical records or insurance information, if required.
7. Review the completed form one last time to ensure that all the necessary information has been provided and that there are no empty or skipped sections.
8. Sign and date the form as requested. Some forms may require additional signatures, such as from a healthcare provider or witness.
9. Make a copy of the entire completed form for your records before sending it.
10. Fax the completed tobacco cessation quitline form to the provided fax number. Always retain the confirmation or receipt of transmission for future reference.

Who needs tobacco cessation quitline fax:

1. Individuals who are looking to quit tobacco use and seek assistance and support from a dedicated quitline.
2. Those who want to access resources, counseling, or medication options to aid in their tobacco cessation journey.
3. Healthcare providers who are assisting their patients in quitting tobacco and want to refer them to a quitline for additional support and specialized services.
4. Organizations or businesses that want to provide resources and information about tobacco cessation to their employees or community members.

Overall, both individuals and supportive professionals can benefit from utilizing a tobacco cessation quitline fax to access the necessary resources and support for achieving a tobacco-free lifestyle.

For pdfFiller’s FAQs

What is tobacco cessation quitline fax?

The tobacco cessation quitline fax is a form used to report information related to tobacco cessation services provided by healthcare facilities.

Who is required to file tobacco cessation quitline fax?

Healthcare facilities that offer tobacco cessation services are required to file the tobacco cessation quitline fax.

How to fill out tobacco cessation quitline fax?

The tobacco cessation quitline fax must be completed with details of the tobacco cessation services provided, including the number of participants, types of services offered, and outcomes.

What is the purpose of tobacco cessation quitline fax?

The purpose of the tobacco cessation quitline fax is to track and report on the effectiveness of tobacco cessation services offered by healthcare facilities.

What information must be reported on tobacco cessation quitline fax?

Information such as the number of participants, types of services offered, outcomes, and follow-up data must be reported on the tobacco cessation quitline fax.

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