Get Tobacco Use Assessment (11430 - - Advantage Health Solutions

Filling out the Tobacco Use Assessment is an important step for individuals who currently use or have used tobacco products. This guide will provide you with a clear, step-by-step approach to completing the assessment accurately and thoroughly.

Follow the steps to complete the Tobacco Use Assessment.

1. Click ‘Get Form’ button to obtain the Tobacco Use Assessment questionnaire. This action will allow you to access the document for completion.
2. Start by filling in your personal details. Enter your full name, today's date, address, age, gender, and social security number. Ensure that all information is accurate and legible.
3. Provide your employment details. Indicate your employer's name and the name of your primary care physician.
4. In the Smoking/Tobacco Use History section, indicate your current or past use of tobacco products. Specify whether you are a current smoker, former smoker, or if you use smokeless tobacco products.
5. Answer the questions regarding your tobacco use. Include information about how long ago you stopped, the age you began using, and the number of tobacco products used daily.
6. Respond to questions about your attempts to quit smoking. Indicate how many times you've tried to stop, methods used for cessation, and note any barriers you faced.
7. Complete the medical history section by indicating any current or past health conditions. If applicable, answer whether you are currently pregnant.
8. In the Current Plan to Stop Smoking section, express your interest level in quitting and your confidence in succeeding. Indicate the smoking status of people around you, including family members and friends.
9. Review all entries to ensure accuracy and completeness. Once satisfied, save your changes.
10. After finalizing your answers, proceed to download, print, or share the completed Tobacco Use Assessment questionnaire, and return it to ADVANTAGE Health Plan as instructed.

Complete your Tobacco Use Assessment online to help us provide you with the best support.