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BABY & ME Tobacco Free FAXTOQUIT Community Agency Referral Form To: Weld County WIC FAX: 9703951176 CLIENT INFORMATION (PLEASE PRINT) Patient Name:___ Date of Birth: ___/___/___ Address: ___ Email
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How to fill out tobacco fax-to-quit community agency
How to fill out tobacco fax-to-quit community agency
01
Gather all necessary information and forms from the tobacco fax-to-quit community agency.
02
Complete the required fields on the fax-to-quit form accurately and legibly.
03
Include your contact information so the agency can follow up if needed.
04
Fax the completed form to the designated number provided by the agency.
05
Wait for confirmation from the agency that they have received your fax and are processing your request.
Who needs tobacco fax-to-quit community agency?
01
Individuals who are trying to quit smoking or using tobacco products.
02
People who are seeking support and resources to help them quit tobacco use.
03
Community members who are interested in utilizing free services and assistance to kick the habit.
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What is tobacco fax-to-quit community agency?
Tobacco fax-to-quit community agency is a program that provides support to individuals looking to quit smoking by offering resources and assistance via fax.
Who is required to file tobacco fax-to-quit community agency?
Healthcare providers and community organizations that are offering the fax-to-quit program are required to file tobacco fax-to-quit community agency.
How to fill out tobacco fax-to-quit community agency?
To fill out the tobacco fax-to-quit community agency, providers must submit information about the program, number of participants, and outcomes achieved.
What is the purpose of tobacco fax-to-quit community agency?
The purpose of tobacco fax-to-quit community agency is to help individuals quit smoking by providing support and resources through a fax-based program.
What information must be reported on tobacco fax-to-quit community agency?
Providers must report the number of participants in the program, outcomes achieved, and any challenges faced while implementing the program.
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