Get the free Oregon Quitline Fax Referral Form in English

Oregon Tobacco Quit Line Fax Referral Form Fax Number: 18004833114Provider Information:FAX SENT DATE: / / NAME OF CLINIC, PRACTICE, PHARMACY OR HOSPITALCLINIC ZIP CODEREQUIRED: I AM A HIPAA COVERED

How to fill out oregon quitline fax referral

How to fill out oregon quitline fax referral

1. Obtain the required referral form from the Oregon Quitline.
2. Fill out the referral form completely, providing all necessary information.
3. Make sure to include the name, contact information, and demographics of the person being referred.
4. Provide relevant tobacco use history and any additional details that may be required.
5. Indicate the reason for the referral and any specific concerns or goals regarding quitting smoking.
6. Fax the completed referral form to the designated fax number provided by the Oregon Quitline.
7. Keep a copy of the fax confirmation receipt for your records.
8. Follow up with the Oregon Quitline to confirm receipt of the referral and discuss any further steps.

Who needs oregon quitline fax referral?

1. Oregon Quitline fax referral is needed by individuals or healthcare professionals who wish to refer someone to the Oregon Quitline for assistance in quitting smoking.
2. It is particularly useful for healthcare providers who want to ensure that their patients receive additional support and resources to quit smoking.

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What is oregon quitline fax referral?

Oregon Quitline fax referral is a means for healthcare providers to refer patients to the Oregon Quitline service for assistance with quitting tobacco.

Who is required to file oregon quitline fax referral?

Healthcare providers who have patients interested in quitting tobacco are required to file Oregon Quitline fax referral.

How to fill out oregon quitline fax referral?

Oregon Quitline fax referral can be filled out by providing patient information, reason for referral, and any additional relevant details.

What is the purpose of oregon quitline fax referral?

The purpose of Oregon Quitline fax referral is to connect patients who want to quit tobacco with resources and support through the Quitline service.

What information must be reported on oregon quitline fax referral?

Patient demographics, reason for referral, healthcare provider information, and any relevant medical history must be reported on Oregon Quitline fax referral.