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Sobre los programas de Quitline
Cómo funciona el programa
Ayudando amigos familia
Preguntas frecuentes
Recursos
Sobre cómo dejarlo
>
Estrategias comprobadas
Experiencias exitosas
Beneficios de dejarlo
Fumar afecta a sus seres queridos
Efectos del tabaco en tu salud
Tobaco y Tu
Tu decisión de dejarlo
Profesionales de la salud
>
Remisión
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Remisión
Utilice el formulario a continuación si desea referir a alguien al programa.
Prefiero la remisión por fax
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El paciente ha dado su consentimiento para recibir mensajes de texto con mensajes motivadores diseñados para ellos y otros eventos del programa, como recordatorios de citas y aniversarios para dejar de fumar.
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Se pueden aplicar tarifas estándar de mensajes y datos. El paciente puede optar por no participar en cualquier momento.
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¿Necesita el paciente adaptaciones mientras participa en el programa, como TTY, traductor o servicio de retransmisión?
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En caso afirmativo, especifique:
Provider Information
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Aetna Better Health of Kentucky
ARH Appalacian Regional Healthcare
Baptist Medical Associates, Kriesge III
Berea Health Ministry
Breckenridge Health, INC.
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Cincinnati Childrens Hospital
Commonwealth Biomedical Research, LLC
Communicare
Crittenden County Health Dept.
Daviess County Community Health Center
Deacones Hospital
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Deaconess Clinic, Orthopaedic Associates
Dr Kershner
ENT & Allergy Specialists
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Graves-Gilbert Clinic
Grayson County Health Department
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Norton Community Medical Associates - Brownsboro
Ohio County Health Center
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Owensboro Family Medicine
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Pennyrile District Health Dept/Crittenden Co Healt
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Pulmonary and Critical Care, College of Medicine,
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Adair County Health Department
Aetna Better Health of Kentucky
ARH Appalacian Regional Healthcare
Baptist Medical Associates, Kriesge III
Berea Health Ministry
Breckenridge Health, INC.
CARINAL STATION
Cincinnati Childrens Hospital
Commonwealth Biomedical Research, LLC
Communicare
Crittenden County Health Dept.
Daviess County Community Health Center
Deacones Hospital
Deaconess Clinic
Deaconess Clinic, Orthopaedic Associates
Dr Kershner
ENT & Allergy Specialists
Family Health Center, East Broadway
Graves-Gilbert Clinic
Grayson County Health Department
GRDHD, Henderson County Health Center
Green River District Health Dept
Hardin County Health Center
Health First Community Health Center
Health Start
Heartland Cares, Inc.
Hillview Medical Clinic
Kentucky Cancer Program
Kentucky River Community Care, INC.
Knox Co health Department
Lincoln Trail District Health Department
Louisville Metro Public Health & Wellness
LTDHD, Family Medical Center
Lyon County Health Center
Lyon County Health Department
Matthew 25
MCAVLEY HEALTH CENTER
Meade Co Health Department
Mercer Co Health Department
Muhlenberg County Health Department
Nelson County Health Department
NKY Center For Pain
Norsworthy Medical Associates
Norton Community Medical Associates - Brownsboro
Ohio County Health Center
OrthoCincy
Our Lady Bellefente Hospital
Owensboro Family Medicine
Park DuValle Community Health Center at Spencer Co
Pendleton County Health Center
Pennyrile District Health Dept/Crittenden Co Healt
Pennyrile District Health Dept/Trigg Co Health De
Pennyroyal Integrated Health Center
Pennyroyal Primary Care
Pulmonary and Critical Care, College of Medicine,
RANK VIA Affiliate Service Area
Regency Rehabilitation and Nursing Center
Rockcastle Regional Hospital
Saint Elizabeth Healthcare, Regional Diabetes Cent
Seven Counties Prevention Division
Seven Counties Services
Seven Counties Services, Inc.
SITC
St Elizabeth Diabetes Center
St Louis University Hosp
St Nicholas Family Clinic
St. Elizabeth
St. Elizabeth Health Care
St. Elizabeth Healthcare
St. Elizabeth Physicians
St. Elizabeth Physicians - Walton
The Center for Women's Health
U of L Family Medicine, Cardinal Station
UK Bluegrass Care Clinic
UK Family Practice
UK Healthcare
University Medical Associates, PSC
University of Louisville - Department of Family &
University of Louisville Hospital
Walgreen Pharmacy
Walgreens
Webster County Health Department
WEDCO - Scott County Health Department
Whitley County Health Department
Whitley County Health Department
WL Family Med - Newbury
National Provider Identifier (NPI)
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¿Cómo le gustaría recibir actualizaciones sobre su paciente?
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Authorization
Como entidad cubierta por HIPAA, estoy autorizado a recibir información de salud personal de la persona referida.
Al enviar este formulario, verifico que el paciente referido ha dado su consentimiento para participar en el programa para dejar de fumar.
Authorization
As a Not Covered Entity, personal health information will not be shared back for the individual being referred.
Al enviar este formulario, verifico que el paciente referido ha dado su consentimiento para participar en el programa para dejar de fumar.
Thank You
Gracias por la referencia.
Quitline llamará a su paciente dentro de las 24 horas.
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