
CALLCENTERFORMS.LUNGUM.ORG
Illinois Tobacco Quitline - Tobacco Treatment Enrollment FormTobacco Treatment Enrollment Form. Required fields are in BOLD. When should we call? 7AM to 10 AM. May we leave a message? HEALTHCARE PROFESSIONAL TOBACCO TREATMENT CHECKLIST. Identify and document patient's tobacco use. In a clear, strong personalized manner, urge patient to quit. Is patient willing to make an attempt? Suggest counseling or pharmacotherapy to assist in quit. By faxing this form, the Illinois Tobacco Quitline will follow-up. Of readiness to quit. A Ready to quit. B Thinking about quitting.
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