How to Refer to the Quitline
The Quitline offers a Fax Referral Program designed to assist you in supporting smoking cessation among your patients. The Indiana Tobacco Quitline is FREE to your Indiana patients, staffed by professionally trained smoking cessation Quit Coaches and designed so you can ASK, ADVISE, and REFER patients to the Quitline. Patients who receive cessation advice from a physician are more likely to try to quit tobacco and have a greater chance of success.
Referring to the Quitline and incorporating the Fax Referral Program into your practice is easy. Just follow these steps:
- ASK your patient about their tobacco use status and document their response.
- ADVISE your patient to quit and assess their readiness to quit within the next 30 days and their interest in receiving phone counseling.
- REFER your patient to the Indiana Tobacco Quitline! If your patient isthey are ready to quit, fill out the Fax Referral form along with your patient and have them sign for consent as required by HIPAA.
- Please include your name and fax number in the provider section
- Have your patient initial and sign the fax referral form in the patient section
- Assist your patient in selecting the best time frame for the Quitline to call.
- Fax the form to: 1-800-483-3114.
- Discuss medication options with your patient.
- Evaluate the quit attempt with a follow up.
We'll take it from there - It's that simple! The Indiana Tobacco Quitline will fax a report back to your office to be placed in your patient's file. The report will tell you whether or not the patient was reached, enrolled in services and planned to quit.
