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You Quit Two Quit

Supporting comprehensive tobacco use screening and cessation counseling for women of reproductive age, before, between and beyond pregnancy.

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Provider Forms and Clinic Resources

This newly updated resource is your go-to guide for enhancing tobacco cessation treatment in your practice! The 2023 issue includes the latest information on pharmacotherapy, billing, ENDS, and other substance use comorbid with tobacco.
Practice Bulletin
Use this resource to guide your 5As counseling with patients and to record information about their tobacco use. Prenatal version.
Prenatal Five As Intervention Record (FAIR Form)
Use this resource to guide your 5As counseling with patients and to record information about their tobacco use. Postpartum version.
Postpartum Five As Intervention Record (FAIR Form)


Use this resource to guide your 5As counseling with patients and to record information about their tobacco use. Non-pregnant version.
Non-Pregnant Five As Intervention Record (FAIR Form)
QuitlineNC Fax Referral Form (English)
QuitlineNC Fax Referral Form (Spanish)


Clinics can create standing orders so that any Public Health Registered Nurse who has proper certification (including the You Quit, Two Quit training we provide!) can provide tobacco cessation counseling.
Sample Standing Orders
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.
Blueprint for Implementing Clinically-Based Tobacco Cessation Programs
An appropriate tobacco-related diagnosis must be filed in addition to the Evaluation and Management code and submitted with the CPT code.
Medicaid Billing Information


Tobacco Screening and Cessation Counseling Pocket Card
An appropriate tobacco-related diagnosis must be filed in addition to the Evaluation and Management code and submitted with the CPT code.
ICD-10 Smoking-Cessation Billing and Diagnostic Counseling Codes
LME-MCO Communication Bulletin #J148


LME-MCO Communication Bulletin #J206
Going Tobacco-Free Staff Guide for Substance Use Treatment Centers
Register your agency for the new web-based Quitline NC portal
Quitline NC Referral Site Registration Form


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