FAX REFERRAL FORM  For Quitline Referrals Fax Completed Form To: [removed]  For Hospital Local Group Cessation Classes See Second Page To be contacted by a Quitline Coach, use this form to refer tobacco users - Rutland Regional Medical Center - Document - PDFSEARCH.IO

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	FAX REFERRAL FORM  For Quitline Referrals Fax Completed Form To: [removed]  For Hospital/Local Group Cessation Classes See Second Page To be contacted by a Quitline Coach, use this form to refer tobacco users Add to Reading List Document Date: 2014-10-27 14:28:19 Open Document File Size: 312,46 KB Share Result on Facebook City Bradford / Windsor / Morrisville / / Facility Mt. Ascutney Hospital / Central Vermont Medical Center / Copley Hospital / / / MedicalTreatment nicotine replacement therapy / / NaturalFeature Upper Valley / / Organization Central Vermont Medical Center Berlin / REFERRING ORGANIZATION / See Reverse For Hospital / Department of Health / / / Position coach / tobacco treatment specialist / Porter / Quitline Coach / / Product nicotine / / ProvinceOrState Vermont / / Region Northeastern Vermont / Central Vermont / / SocialTag Quitline Vermont Smoking cessation Rutland Regional Medical Center Technology Office equipment Fax

FAX REFERRAL FORM  For Quitline Referrals Fax Completed Form To: [removed]  For Hospital/Local Group Cessation Classes See Second Page To be contacted by a Quitline Coach, use this form to refer tobacco users Add to Reading List