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Health Care Providers
Tobacco Quit Kit

Letter from the Health Commissioner (PDF)
Clinical Tools
  • Adult Preventive Care Flow Sheet (PDF)
    To help monitor and document physical examinations, test results, counseling, and immunizations.
  • Materials Request Form (PDF)
    Reorder materials before you run out, or request additional materials from your Health Department representative.
  • Smoking Questionnaire (PDF)
    This patient self-screener can assist you in assessing your patients' smoking habits and readiness to quit.
  • Vital Signs Chart Stickers (PDF)
    Use these stickers in the medical record to incorporate tobacco status into your patient's vital signs. Ask your receptionist, medical assistant or nurse to place one at the top of the visit notes.

Provider Resources

Patient Education Materials

Other Materials

  • Adult Preventive Care Flow Sheet (PDF)
    To help monitor and document physical examinations, test results, counseling, and immunizations.
  • Materials Request Form (PDF)
    Reorder materials before you run out, or request additional materials from your Health Department representative.
  • Smoking Questionnaire (PDF)
    This patient self-screener can assist you in assessing your patients' smoking habits and readiness to quit.
  • Vital Signs Chart Stickers (PDF)
    Use these stickers in the medical record to incorporate tobacco status into your patient's vital signs. Ask your receptionist, medical assistant or nurse to place one at the top of the visit notes.

Provider Resources

Patient Education Materials

Other Materials