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QuitFax Program Protocol
What is it?
ASHLine QuitFax is a simple way to help clients who want to quit tobacco use. One fax referral links a client to telephone-based counseling and community-based cessation classes. Through classes and counseling, clients can receive 50% discounts on medications to help them quit.
Who qualifies?
Open to all Arizona residents with a desire to quit tobacco use!
How does it work?
- Healthcare provider/Employer fills out FAX form and faxes to ASHLine
- ASHLine returns a fax confirmation receipt
- Within 24 hours ASHLine attempts to contact client
- Up to 5 attempts are made within 10 days to reach client
- Client is offered telephone counseling, group classes, or both
- Healthcare provider/Employer is notified of client decision by fax
- Healthcare provider/Employer will be updated quarterly on the status of all clients referred that quarter
1, 2, 3 ... It's easy!
Download and print the QuitFax Referral Form.
Step 1: Fill out the referral agent contact information completely.
Step 2: Fill out client information.
Step 3: Client must sign or give verbal consent.
Questions? We're here to help!
1-800-55-66-222