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CONFIDENTIALCOMMUNITY Domiciliary Smoking Cessation Referral Form Please complete all sections highlighted in red and where possible provide additional information if known. Patients Registered GP:Patients
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How to fill out community domiciliary smoking cessation

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How to fill out community domiciliary smoking cessation

01
Step 1: Start by gathering all the necessary documents and forms required for the community domiciliary smoking cessation program.
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Step 2: Identify the target individuals who are interested in quitting smoking and are suitable candidates for the program.
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Step 3: Conduct an initial assessment to determine the participant's smoking history, level of addiction, and any underlying health conditions.
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Step 4: Develop a personalized smoking cessation plan for each participant, taking into account their individual needs and preferences.
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Step 5: Provide educational materials and resources to participants, including information about the health risks of smoking, benefits of quitting, and strategies for overcoming cravings.
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Step 6: Offer counseling or support groups to participants to help them cope with nicotine withdrawal symptoms and address any psychological or emotional challenges.
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Step 7: Encourage participants to set a quit date and provide them with ongoing assistance and guidance during the cessation process.
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Step 8: Monitor the progress of participants regularly and adjust the cessation plan as needed to ensure maximum success.
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Step 9: Provide continuous support and follow-up care even after participants have successfully quit smoking to help them maintain their smoke-free lifestyle.
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Step 10: Keep track of program outcomes and evaluate the effectiveness of the community domiciliary smoking cessation program to make any necessary improvements for future interventions.

Who needs community domiciliary smoking cessation?

01
Individuals who are struggling with smoking addiction and desire to quit.
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Community members who are exposed to secondhand smoke and want to protect their health.
03
People who have tried to quit smoking on their own but have not been successful and are looking for professional support.
04
Those who have been diagnosed with smoking-related health conditions and need assistance in quitting to improve their overall well-being.
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Individuals who want to engage in a supportive community environment while working towards smoking cessation goals.
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Community domiciliary smoking cessation refers to programs and initiatives aimed at helping individuals quit smoking while providing support and resources within their community settings, often including interventions delivered at home.
Typically, healthcare providers or organizations that administer smoking cessation programs within a community setting are required to file for community domiciliary smoking cessation.
To fill out community domiciliary smoking cessation, one must complete the required forms with participant information, details of the smoking cessation intervention, and any relevant data regarding outcomes and support provided.
The purpose of community domiciliary smoking cessation is to reduce smoking prevalence by offering accessible cessation support tailored to the needs of individuals in their own homes and communities.
Information that must be reported typically includes participant demographics, smoking history, cessation methods used, follow-up results, and other relevant health data.
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