Tobacco Implementation Guide-Products Used For Smoking Cessation
Any Products Used for Smoking Cessation
What is the category for the medication?
*
Were any smoking cessation products taken?
Yes
No
Smoking Cessation Product
Smoking Cessation Product
Choose
Nicotine Patch
Nicotine Gum
Nicotine Lozenge
Nicotine Inhaler
Varenicline
Bupropion
Other
Did the subject previously use the selected product for smoking cessation?
No
Yes
Not Done
What was the name of the other smoking cessation product used?
Was the smoking cessation product discontinued due to an adverse experience?
No
Yes
What was the last date the smoking cessation product was used?
01 Jan 2000
*
Mandatory field