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PROTECTED B (When Completed) Change of Smoking Status Group Policy # 901102 Reset Print 1. MEMBER INFORMATION Service Number (SN) First Name Surname Rank Mailing Address Initials CHECK ONE ONLY: Regular

How to fill out change of smoking status

How to fill out change of smoking status:

1. Locate the appropriate form: Look for the specific form designated for change of smoking status. This form may be available online on the official website of the relevant organization or institution.
2. Provide personal information: Begin by filling out the required personal information section of the form. This typically includes your full name, date of birth, contact information, and any unique identifiers such as a social security number or membership number.
3. Indicate the reason for the change: Clearly state the reason for the change of smoking status. This could be that you have recently quit smoking, switched from smoking to vaping, or have started smoking after previously being a non-smoker. Be honest and accurate in your response.
4. Document the effective date: Specify the date from which the change in smoking status is effective. This is important for organizations that maintain records or statistics related to smoking habits. Ensure the date is correct and corresponds with when your smoking status actually changed.
5. Include any supporting documentation: If required, attach any supporting documentation that substantiates the change in smoking status. This might include a doctor's note, smoking cessation program completion certificate, or any other relevant evidence.
6. Sign and date the form: Once you have completed the form, review all the information for accuracy. Sign and date the form where indicated to certify the information you have provided is true and correct. In some cases, you may need to have the form notarized by a legal authority.

Who needs to change their smoking status?

1. Individuals with health insurance: If you have health insurance coverage, it is important to update your smoking status to ensure accurate premium rates and eligibility for any smoking cessation programs or support.
2. Employees: Many workplaces have policies regarding smoking, including tobacco-free campuses or incentives for non-smokers. If you are an employee, you may need to update your smoking status for compliance or to take advantage of any available benefits.
3. Research participants: If you are participating in a research study or clinical trial that tracks smoking habits, you may need to update your smoking status as part of the study protocol.
4. Government agencies: Certain government agencies or programs may require updated smoking status information for statistical purposes or to determine eligibility for certain benefits or assistance programs.
5. Educational institutions: Colleges or universities may ask for smoking status information for research purposes or as part of efforts to promote a smoke-free campus environment.

It is important to check with the specific organization or institution to determine if and when you need to update your smoking status.

For pdfFiller’s FAQs

What is change of smoking status?

Change of smoking status is the process of updating one's smoking habits or declaring a change in smoking status.

Who is required to file change of smoking status?

Individuals who have recently started or stopped smoking, or have changed their smoking habits are required to file a change of smoking status.

How to fill out change of smoking status?

To fill out change of smoking status, individuals can typically submit a form provided by their healthcare provider or insurance company, indicating the changes in their smoking habits.

What is the purpose of change of smoking status?

The purpose of change of smoking status is to ensure accurate and up-to-date information regarding one's smoking habits, which may impact health insurance premiums or coverage.

What information must be reported on change of smoking status?

Individuals must report any changes in their smoking habits, including starting, stopping, or changes in frequency or quantity of smoking.

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