Tobacco Implementation Guide-Medications Used for Nicotine Dependency
Medications
What was the medically recognized product name?
Pre-Specified Intervention
Did the subject previously use the selected product for smoking cessation?	No  Yes  Not Done
How many times did the subject attempt to use medically recognized products to attempt to reduce nicotine dependency?
Category
LAST ATTEMPT FOR EACH MEDICATION TYPE
What is the category of the medication/product the subject used to attempt to reduce nicotine dependency?	Nicotine Replacement Therapy (NRT)  Not a NRT
What is the medication/product subcategory, if not pre-printed on the CRF.
What was the name of the medication/product the subject used to reduce nicotine dependency?
What was the duration of the medication/product used to reduce nicotine dependency for the last attempt?
What was the duration unit of the medication/product used to reduce nicotine dependency for the last attempt?	Days  Month  Years

* Mandatory field