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Beneficios de dejarlo
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Tobaco y Tu
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Remisión
Utilice el formulario a continuación si desea referir a alguien al programa.
Prefiero la remisión por fax
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Provider Information
Información de la clínica
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UAP Utah County Health Department
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Baby Steps/Baby Your Baby
Bear River Health Department - Box Elder County
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Beaver Medical Clinic
Cache Valley Community Health Center Providence
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CHC - 72nd Street Clinic
Children's Service Society of Utah
Cobble Creek Dental
Davis Family Physicians-Ogden Clinic
Department of Corrections – Fortitude Treatment Center
Early Learning Essentials
Ellis Shipp Immunization Clinic
Exodus Healthcare Network
Family Healthcare
Fifth District Juvenile Court
Food & Care Coalition
Food & Care Coalition
Gagon Family Practice
Granger Medical Clinic Allergy, Asthma & Immunology
HCI Center for Hope
Head Start - BEAR RIVER HEAD START
Head Start - Centro De La Familia De Utah
Head Start - Davis School District
Head Start - DDI Vantage
Head Start - Early Learning Essentials
Head Start - Kids On The Move, Inc.
Head Start - Ogden-Weber Community Action Partnership, Inc.
Head Start - Root For Kids
Head Start - RURAL UTAH CHILD DEVELOPMENT
Head Start - Salt Lake Community Action Program
Head Start - Southern Utah University Head Start
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Huntington Family Dental
Intermountain Healthcare – Alta View Internal Medicine
Intermountain Healthcare – North Temple Urgent Care
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Karen Murray Radley, M.D.
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UH Pulmonary
University of Utah - Respiratory Therapy Group
University of Utah - West Valley Dialysis
University of Utah – Cardiovascular Center
University of Utah – DFPM Project IMPACT
University of Utah – Hospital – Medicine Unit (5th Floor)
University of Utah – Surgical Specialties and Transplant Clinic
University of Utah – UNI
University of Utah – Vascular Surgery
University Of Utah Farmington Health Center
University of Utah Health
University of Utah Health Plans
University of Utah School of Dentistry
UT - Paiute Indian Tribe of Utah
UT Tech University Booth Wellness Center
UT Tech University Dental Hygiene Clinic
Utah Center for Bleeding and Clotting Disorders
Utah State Hospital
Utah State Office of Rehabilitation
Valley Women's Health - St. George Office
Wasatch Behavioral Health – Outpatient Substance Use Treatment
Wasatch Behavioral Health – Payson Family Clinic
Wasatch Behavioral Health – Substance Use Disorder Division
Wasatch Behavioral Health – Westpark Family Clinic
Wasatch Pediatrics – Southpoint
Weber Morgan Health Dept
Welcome Baby
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WIC Kanab
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WIC Moab
WIC Montezuma Creek
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WIC Panguitch
WIC Park City
WIC Payson
WIC Price
WIC Provo
WIC Randolph
WIC Richfield
WIC Roosevelt
WIC Salt Lake
WIC Saratoga Springs
WIC South East
WIC South Main
WIC South Redwood
WIC St. George
WIC Tooele
WIC Tremonton
WIC Vernal
WIC Wendover
Nombre de la clínica/organización
Clínicas
Select
UAP Utah County Health Department
United Way of Utah County
Baby Steps/Baby Your Baby
Bear River Health Department - Box Elder County
Bear River Health Department - Cache County
Beaver Medical Clinic
Cache Valley Community Health Center Providence
Centro Hispano
CHC - 72nd Street Clinic
Children's Service Society of Utah
Cobble Creek Dental
Davis Family Physicians-Ogden Clinic
Department of Corrections – Fortitude Treatment Center
Early Learning Essentials
Ellis Shipp Immunization Clinic
Exodus Healthcare Network
Family Healthcare
Fifth District Juvenile Court
Food & Care Coalition
Food & Care Coalition
Gagon Family Practice
Granger Medical Clinic Allergy, Asthma & Immunology
HCI Center for Hope
Head Start - BEAR RIVER HEAD START
Head Start - Centro De La Familia De Utah
Head Start - Davis School District
Head Start - DDI Vantage
Head Start - Early Learning Essentials
Head Start - Kids On The Move, Inc.
Head Start - Ogden-Weber Community Action Partnership, Inc.
Head Start - Root For Kids
Head Start - RURAL UTAH CHILD DEVELOPMENT
Head Start - Salt Lake Community Action Program
Head Start - Southern Utah University Head Start
Head Start - Ute Indian Tribe
Huntington Family Dental
Intermountain Healthcare – Alta View Internal Medicine
Intermountain Healthcare – North Temple Urgent Care
Intermountain Healthcare eReferral
Intermountain IMC_ROC
Intermountain LDSH_ROC
Kamas Health Center
Karen Murray Radley, M.D.
Kazan Memorial Clinic
LDS Hospital Pulmonary Clinic
Maliheh Free Clinic
Mckay Dee Porter Clinic
McKay Dee Respiratory
Mojave Health
Molina Healthcare
Mountain West Medical Center
Mountainlands Family Health Center
Onsite Care Clinics – Orbit
Onsite Care Clinics – Overstock.com
Payson Regional Dialysis Center
Public Health Nursing – TCM (South Main)
Rocky Vista Health Center
Sacred Circle Healthcare
Salt Lake Immunization Clinic
San Juan Clinic
South Main Immunization Clinic
South Redwood Immunization Clinic
Southeast Immunization Clinic
Southwest Behavioral Health Center - Horizon House West
Southwest Utah Public Health Department
St. Mark’s Family Medicine
Steward Health Choice Utah
Timpanogos Community Treatment Center
UAP Salt Lake County Health Department
UAP Southeast Utah Health Department
UAP TriCounty Health Department
UH Pulmonary
University of Utah - Respiratory Therapy Group
University of Utah - West Valley Dialysis
University of Utah – Cardiovascular Center
University of Utah – DFPM Project IMPACT
University of Utah – Hospital – Medicine Unit (5th Floor)
University of Utah – Surgical Specialties and Transplant Clinic
University of Utah – UNI
University of Utah – Vascular Surgery
University Of Utah Farmington Health Center
University of Utah Health
University of Utah Health Plans
University of Utah School of Dentistry
UT - Paiute Indian Tribe of Utah
UT Tech University Booth Wellness Center
UT Tech University Dental Hygiene Clinic
Utah Center for Bleeding and Clotting Disorders
Utah State Hospital
Utah State Office of Rehabilitation
Valley Women's Health - St. George Office
Wasatch Behavioral Health – Outpatient Substance Use Treatment
Wasatch Behavioral Health – Payson Family Clinic
Wasatch Behavioral Health – Substance Use Disorder Division
Wasatch Behavioral Health – Westpark Family Clinic
Wasatch Pediatrics – Southpoint
Weber Morgan Health Dept
Welcome Baby
WIC American Fork
WIC Beaver
WIC Blanding
WIC Brigham City
WIC Castle Dale
WIC Cedar City
WIC Clearfield
WIC Coalville
WIC Delta
WIC East Carbon
WIC Ellis Shipp
WIC Fillmore
WIC Garden City
WIC Green River
WIC Heber City
WIC Junction
WIC Kamas
WIC Kanab
WIC Loa
WIC Logan
WIC Manti
WIC Moab
WIC Montezuma Creek
WIC Monticello
WIC Monument Valley
WIC Morgan
WIC Nephi
WIC Ogden
WIC Panguitch
WIC Park City
WIC Payson
WIC Price
WIC Provo
WIC Randolph
WIC Richfield
WIC Roosevelt
WIC Salt Lake
WIC Saratoga Springs
WIC South East
WIC South Main
WIC South Redwood
WIC St. George
WIC Tooele
WIC Tremonton
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WIC Wendover
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¿Cómo le gustaría recibir actualizaciones sobre su paciente?
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Authorization
Como entidad cubierta por HIPAA, estoy autorizado a recibir información de salud personal de la persona referida.
Al enviar este formulario, verifico que el paciente referido ha dado su consentimiento para participar en el programa para dejar de fumar.
Authorization
As a Not Covered Entity, personal health information will not be shared back for the individual being referred.
Al enviar este formulario, verifico que el paciente referido ha dado su consentimiento para participar en el programa para dejar de fumar.
Thank You
Gracias por la referencia.
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