Question 1: Does the recipient have a history of smoking cigarettes?

The intent of this question is to determine the recipient’s history of smoking, including cigars, pipe tobacco, e-cigarettes, and marijuana, and / or use of chewing tobacco. The recipient’s smoking and / or chewing history is usually documented on the transplant admission summary.

Indicate whether the recipient has a history of smoking or using chewing tobacco. If “yes,” continue with question 2. If “no” or “unknown” continue with question 4.

Question 2: Specify smoking or chewing use (check all that apply)

Indicate the recipient’s smoking and / or chewing tobacco use from the options listed. If “cigarettes” is selected, continue with question 3.

Question 3: Has the recipient smoked cigarettes within the past year?

Indicate if the recipient has a history of smoking cigarettes within the year prior to HCT. Do not include chewing tobacco, cigars / pipe, e-cigarettes, or marijuana.

Last modified: Jan 28, 2020

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