APPENDIX 1 C
DATA COLLECTION INSTRUMENTS and
electronic contact Record Form (ECRF)
REACTIVE SMOKING CESSATION Questions
(customer service and demographics questions)
Public Burden Statement
Smoking Cessation Intake Form (SCIF): Dependency Tab > Summary
Smoking Cessation Intake Form (SCIF): Dependency Tab Symptoms
Smoking Cessation Intake Form (SCIF): Dependency Tab > Triggers
Smoking Cessation Intake Form (SCIF): Dependency Tab > Past Meds
Smoking Cessation Intake Form (SCIF): Dependency Tab > Future Meds
Smoking Cessation Intake Form (SCIF): Motivation Tab
Electronic Coding Records Form (ECRF): seen within the Service Tab
Spanish Version
Electronic Coding Records Form (ECRF): seen within the Service Tab
Customer Service Questions
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | ilene Holly Burstyn |
File Modified | 0000-00-00 |
File Created | 2021-01-30 |