alcohol-screening-questionnaire-template.pdf - Alcohol screening questionnaire(AUDIT Patient name Drinking alcohol can affect your health and some

alcohol-screening-questionnaire-template.pdf - Alcohol...

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One drink equals: 12 oz. beer 5 oz. wine 1.5 oz. liquor (one shot) 1. How often do you have a drink containing alcohol? Never Monthly or less 2 - 4 times a month 2 - 3 times a week 4 or more times a week 2. How many drinks containing alcohol do you have on a typical day when you are drinking? 0 - 2 3 or 4 5 or 6 7 - 9 10 or more 3. How often do you have four or more drinks on one occasion? Never Less than monthly Monthly Weekly Daily or almost daily 4. How often during the last year have you found that you were not able to stop drinking once you had started? Never Less than monthly Monthly Weekly Daily or almost daily 5. How often during the last year have you failed to do what was normally expected of you because of drinking? Never Less than monthly Monthly Weekly Daily or almost daily 6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? Never Less than monthly Monthly Weekly Daily or almost daily 7. How often during the last year have you had a feeling of guilt or remorse after drinking?
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  • Fall '19
  • Alcoholic beverage, liver damage

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