Three Ways to Refer

1. Use your Electronic Health Record (EHR) to send the Fax!

If you have an EHR that can route documentation to a fax number, you can create a telephone note with all of the information you input into the QuitlineNC Fax referral form included, and then route that to the QuitlineNC Fax number using your EHR.

Instructions for Epic EHR (including creating a smartphrase and screenshots) (DOCX, 2.3 MB)

If you use a different EHR, feel free to use this referral documentation template (DOCX, 17 KB) to make sure you include the needed information in your referral.

2. Secured Email

Send a secured email (that means an encrypted, HIPAA compliant email) with:

  • Your state, clinic name and the date in the title; No patient information in the title, that would be a HIPAA violation!; Ex: North Carolina: Porter Clinic - 10/19/2019
  • The referral information can be included as an attachment or in the body of the email

Instructions on how to refer using secured email (DOCX, 18 KB)

You can use the form on the second page of the instructions (DOCX, 18 KB) as a template for either an email attachment or copy and paste it into the body of your secured email.

To send referral information for multiple referrals in one attachment, use the Referral via Secure Email Excel Template (XLS, 24 KB).

Send secured emails to:

3. Fax

Fill out the fax referral form in English or Spanish and Fax to QuitlineNC at 1-800-483-3114.


Check out this recorded webinar for step-by-step instructions and screenshots: Teleworking and Referrals to QuitlineNC.