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1615 West Chester Pike, Suite 104 West Chester, PA 19382 800.425.4657 www.wellworksforyou.com info wellworksforyou.comTOBACCO ATTESTATION FORM EMPLOYEE INFORMATION Employee Name: (Please Print)Employee.

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Successful intervention begins with identifying users and appropriate interventions based upon the patient's willingness to quit. The five major steps to intervention are the "5 A's": Ask, Advise, Assess, Assist, and Arrange. Ask - Identify and document tobacco use status for every patient at every visit.

Smoking cessation counseling can help you quit smoking. Eligibility. Medicare Part B covers two smoking cessation counseling attempts each year if you use tobacco. Each counseling attempt includes up to four face-to-face sessions with your provider, for a total of up to eight sessions.

ICD-10 code Z71. 6 for Tobacco abuse counseling is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

What is tobacco attestation? Tobacco attestation is the section of the enrollment process for the State Health Plan that asks a question about tobacco use. All State Health Plan members (employee only) must complete the tobacco attestation in order to eliminate the default surcharge of $60 a month for 2023.

Report CPT® code 90837 for the 60-minute psychotherapy session and 99406, and append the -59 modifier, indicating that 3-10 minutes of smoking and tobacco use cessation counseling was performed as an independent service.

Items to document may include to following elements: The patient's tobacco use. Advised to quit and impact of smoking. Assessed willingness to attempt to quit. Providing methods and skills for cessation. Medication management of smoking session drugs. Resources provided. Setting quit date. Follow-up arranged.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232