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Tobacco Cessation Counseling
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Pathway to Hope LLC
"5A's" Tobacco Cessation Counseling
Name
*
Email
*
Phone
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Date:
Beginning time:
Ending time:
ASK every client every time (1 minute):
Does not use tobacco
Recently quit smoking
Less than 25 units per day
25+ units per day
Advise all tobacco users of the consequences of tobacco use (1 minute):
Benefits of quitting and encourage recent quitters to continue abstinence
Harms of continuing, compelling evidence that is relevant to the consumer about the importance of quitting
Coughing, Lung and other forms of cancer, Shortness of breath, Gum disease and tooth loss, Premature signs of aging, Emphysema, Cardiovascular disease, Respiratory disease.
Women who smoke have a higher risk of never becoming pregnant
Women who smoke during pregnancy have a greater chance of complications
Personalized message to quit
Recognize difficulty of quitting
Assess willingness to make a quit attempt (1 minute):
is the consumer willing to quit within the next 30 days
if the consumer is willing to attempt to quit using tobacco, move on to the Assist step
if the consumer is not willing to quit,
treatment Email (1
Reason for not quitting:
Assist with treatment and referrals (3+ minutes):
Set Quit Date:
Problem-solving
Provide materials
ldentify Support
Refer to 1-800-QUIT NOW
Pharmacotherapy
Arrange follow-up (1 minute):
Assess tobacco status at every visit
Client about the quitting process
Reinforce the steps the patient is taking to quit
Provide encouragement
Set follow up appointment
Submit
Information Regarding Depression
Payments
Information Regarding Depression
Payments
Home
About
Our services
Schedule Appointment
Insurance
Assessments
Information Regarding Depression
Payments
Home
About
Our services
Schedule Appointment
Insurance
Assessments
Information Regarding Depression
Payments
