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CABLE: TOBACCOFREE TOOLKITAPPENDIX L: TOBACCO USE ASSESSMENT (TUA)Tobacco
Uses
Assessment
ACB HCS
Tobacco
Assessment
TUA
Date ofAssessmentName ___ ID # ___ Birth ___ Date ___
1. Do you live with a
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04
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05
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What is tobacco-use-assessment-short-formpdf?
This is a form used to assess tobacco use.
Who is required to file tobacco-use-assessment-short-formpdf?
All tobacco users are required to file this form.
How to fill out tobacco-use-assessment-short-formpdf?
The form can be filled out by providing accurate information about tobacco use.
What is the purpose of tobacco-use-assessment-short-formpdf?
The purpose of this form is to assess the extent of tobacco use.
What information must be reported on tobacco-use-assessment-short-formpdf?
Information regarding tobacco consumption habits must be reported on this form.
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