The electronic referral (e-referral) program and the fax referral program links tobacco users to the Arkansas Tobacco Quitline. As a health care provider, you play an important role in your patients’ wellbeing and overall health. For patients who use tobacco and nicotine products, you are an important source of information and support in their cessation efforts.
The E-Referral program is designed to help refer tobacco and nicotine users to the Arkansas Tobacco Quitline. Once a referral is submitted, the tobacco or nicotine user will receive a call from a Quit Counselor within 24 hours. Anyone who is referred should be planning a quit date within the next 30 days. Quit Counselors work with tobacco and nicotine users to create a customized, individual quit plan, which includes free counseling services by phone, online, or both.
HIPPA compliant providers are able to create an account to receive outcome reports for the individuals referred. Once an account is created, they will be able to submit referrals and receive feedback up to five times throughout the program.
- When a fax or e-referrals is received
- At the time the patient enrolls in coaching (or if the patient is unreachable)
- When a patient is shipped NRT
- When a patient completes the program
- When a patient dis-enrolls for another reason
Fax Referral Program
This program gives concerned community partners and health care providers another way to connect to the Quitline. A HIPAA-compliant fax referral form secures the prospective quitter’s consent to have the Quitline get in touch. The form is then faxed to the Quitline, so Quit Counselors can contact the patient at a time convenient for the caller. The fax referral form is available in English and Spanish.