Several tools have been included in this toolkit to aid the clinician in the communication with and education of tobacco-dependent patients and their referring physicians. It is not necessary to use all the tools for every patient. The clinician should evaluate the tools and use those that make sense and are most useful to effectively treat tobacco dependence in clinical practice.
The tobacco Evaluation Report/Letter may be used by the clinician to communicate a referred patient’s tobacco use and proposed treatment plan to the referring physician.
Sample Insurance Appeal Letter
Denial of coverage by payers for medications used to treat tobacco dependence may be appealed using the Sample Insurance Appeal Letter.
Behavioral Homework” Worksheet
The Behavioral Homework Worksheet assists the patient in recording his or her tobacco use behavior, such as identifying when the patient smokes and describing the patient’s smoking routine; the worksheet also provides a template for creating a plan to change his or her routine.
Freedom From Tobacco Action Plan
The Freedom From Tobacco Action Plan was designed to aid the clinician in developing a treatment plan and helping the patient to comfortably stop smoking.
Patient Education Brochures
The following is a list of Patient Education Brochures that may be formatted and printed for the clinician to hand out to patients who use tobacco and who may be considering quitting.