How often during the last year Daily Less have you failed to do what was or Never than Monthly Weekly normally expected from you almost monthly daily because of your drinking? How often during the last year Daily have you needed an alcoholic Less or drink in the morning to get than Monthly Weekly almost yourself going after a heavy monthly daily drinking session? Daily How often during the last year Less or have you had a feeling of guilt than Monthly Weekly almost or remorse after drinking? monthly daily How often during the last year Daily have you been unable to Less or remember what happened the Never than Monthly Weekly almost monthly night before because you had daily been drinking? Yes, Yes, Have you or somebody else but not during been injured as a result of your No in the the drinking? last last year year Has a relative or friend, doctor Yes, Yes, or other health worker been but not during concerned about your drinking No in the the or suggested that you cut last last year year down? Scoring: 0 7 Lower risk, 8 15 Increasing risk, – – 16 19 Higher risk, 20+ Possible dependence – TOTAL Score equals: AUDIT C Score (prev.page) + Score of remaining AUDIT questions (this page)
How often during the last year have you failed to do what was normally expected from you because of your drinking? Never Less than monthly Monthly Weekly Daily or almost daily How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? Less than monthly Monthly Weekly Daily or almost daily How often during the last year have you had a feeling of guilt or remorse after drinking? Less than monthly Monthly Weekly Daily or almost daily How often during the last year have you been unable to remember what happened the night before because you had been drinking? Never Less than monthly Monthly Weekly Daily or almost daily Have you or somebody else been injured as a result of your drinking? No Yes, but not in the last year Yes, during the last year Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down? No Yes, but not in the last year Yes, during the last year Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk, 16 – 19 Higher risk, 20+ Possible dependence TOTAL Score equals: AUDIT C Score (prev.page) + Score of remaining AUDIT questions (this page)
New%20patient%20registration%20questionnaire%20with%20Audit%20C%20(2).docx