Form 4 Smoking Cessation Reactive Service Client Questions
Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI Cancer Information Service (CIS) Clients
Appendix 2 C Smoking Cessation Quitline Reactive Qs
CIS Smoking Cessation Reactive Service Clients "Demographic" Questions
OMB: 0925-0208
APPENDIX 2 C
DATA COLLECTION INSTRUMENTS and
electronic contact Record Form (ECRF)
reactive smoking cessation
“Quitline” questions
SMOKING CESSATION “QUITLINE” REACTIVE DEMOGRAPHIC AND
INTAKE QUESTIONS
OMB No. 0925-0208
Expiry Date: 9/30/2012
Current Smoking Cessation Intake Questions – Background Component
Current Smoking Cessation Intake Questions – Dependency Component
D
Current Smoking Cessation Intake Questions – Motivation Component
Current Smoking Cessation Intake Questions – Intervention Component
Current Smoking Cessation Intake Questions – Callback Component
(May we contact you in the future to see how you’re doing and offer additional assistance?)
Current Smoking Cessation Intake Questions – Customer Service Component
Current Smoking Cessation Intake and Follow-up Questions – Demographics Component
| File Type | application/msword |
| File Title | APPENDIX 2 |
| Author | baswad |
| Last Modified By | clharget |
| File Modified | 2009-05-15 |
| File Created | 2009-05-15 |
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