UHA Tobacco Referral System Question Title * 1. Do you have quit promotional materials, like brochures or fliers, available in exam rooms? Yes No If yes, please specify the types of promotional materials. OK Question Title * 2. Are you interested in receiving a supply of brochures or flyers to have available in your clinic exam rooms? Yes No If yes, how many exam rooms do you have? OK Question Title * 3. What is your current process for referrals when the patient has expressed interest in quitting ? Distribute educational materials Refer patients to the “Quit for Life” Program Other (please specify) OK Question Title * 4. What systems do you have in place to make sure tobacco use is addressed at patient visits? Tobacco use status as part of vital signs Registry of patients who use tobacco Other (please specify) OK DONE