Provider Forms and Clinic Resources
Five A’s Invention Record (FAIR) Form
Use this resource to guide your 5As counseling with patients and to record information about their tobacco use. Choose the forms for prenatal women, postpartum women, or non-pregnant adults.
A proactive referral to the Quitline can help your patients quit tobacco for good. As HIPAA protected entities, providers can receive patient outcome report from the Quitline. Be sure to check “yes” by the statement “I am a HIPAA-Covered Entity.”
To help patients feel more comfortable picking up the phone, it’s also a good idea to have them save the Quitline’s number in their contacts!
Sample Standing Orders
This newly updated resource is your go-to guide for enhancing tobacco cessation treatment in your practice! The 2017 issue includes the latest information on pharmacotherapy, billing, ENDS, and trauma-informed care.
Blueprint for Implementing Clinically-Based Tobacco Cessation Programs
This comprehensive 2014 guide helps clinicians and administrators implement tobacco cessation programs in a variety of healthcare settings. It offers tools, resources, and suggested processes to support effective tobacco-cessation programs.