AUDIT

Our clinic asks all patients about alcohol use at least once a year. Drinking alcohol can affect your health and some medications you may take.  Please help us provide you with the best medical care by answering the questions below.

One drink equals:  
12 oz. Beer
 5 oz. Wine
1.5 oz. Liquor (one shot)

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* 1. Please complete:

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* 3. How often do you have a drink containing alcohol?

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* 4. How many drinks containing alcohol do you have on a typical day when you are drinking?

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* 5. How often do you have four or more drinks on one occasion?

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* 6. How often during the last year have you found that you were not able to stop drinking once you had started?

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* 7. How often during the last year have you failed to do what was normally expected of you because of drinking?

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* 8. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

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* 9. How often during the last year have you had a feeling of guilt or remorse after drinking?

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* 10. How often during the last year have you been unable to remember what happened the night before because of your drinking?

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* 11. Have you or someone else been injured because of your drinking?

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* 12. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down?

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* 13. Have you ever been in treatment for an alcohol problem?

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