Form 5 Smoking Cessation Proactive Follow-Up
Collection of Customer Service, Demographic and Smoking/Tobacco Use Information from NCI Cancer Information Service (CIS) Clients
Appendix 2 D Smoking Cessation Quitline Proactive Qs
CIS Smoking Cessation Proactive Callback Follow-ups
OMB: 0925-0208
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APPENDIX 2 D
DATA COLLECTION INSTRUMENTS and
electronic contact Record Form (ECRF)
Proactive smoking cessation
“Quitline” question
OMB No. 0925-0208
Expiry Date: 9/30/2012
SMOKING CESSATION (QUITLINE) PROACTIVE CALLBACK SERVICE CLIENTS
Proactive smoking cessation callers are asked:
When was the last time you smoked a cigarette, even a puff?
| File Type | application/msword |
| File Title | APPENDIX 2 |
| Author | baswad |
| Last Modified By | Vivian Horovitch-Kelley |
| File Modified | 2009-05-18 |
| File Created | 2009-05-18 |
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