Developing an Office Protocol for Smoking Cessation

Starting a new protocol in your office can be challenging.  It takes time to train staff and divide tasks.  Please use this checklist to develop a smoking cessation implementation strategy that best fits your practice.


Staff Member Responsible for Task

Step 1: Chart preparation  

  • ALL patients should be screened at their annual visit about their smoking status.



Step 2:  Check-In

  • Ensure that every patient is given the Smoking Survey when checking in for their annual exam. Consider adding smoking survey in the office intake sheet.

  • If the patient is not a smoker, they should be instructed to hand the survey back to the receptionist.

  • Detach and collect the office portion of the survey from the patient prior to their exam with the doctor so it can be reviewed and discussed.  Give the educational portion of the survey back to the patient.



Step 3:  During the Visit

  • Determine if the patient is a casual/occasional smoker.

  • Discuss the Smoking Survey with the patient and counsel and refer the patient.  Provide patient education materials.

  • Ask if you can call them to follow-up about their “quit” attempt.

  • Document all conversations and referrals with individual patients in their medical record.



Step 4: After Visit

  • Ensure that the Smoking Survey is added to their medical chart.

  • Follow-up with flagged patients as needed.




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