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AUDIT-C

AUDIT-C - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #


NM#800036 (Rev. 06/9/16) Worksheet Only – Not a Medical Record Document
UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
AUDIT-C





Instructions: For each question, please check  the answer that is correct for you.

1. How often do you have a drink containing alcohol?
□ Never (0)
□ Monthly or less (1)
□ Two or four times a month (2)
□ Two to three times a week (3)
□ Four or more times a week (4)


2. How many drinks containing alcohol do you have on a typical day when you are drinking?
□ 1 or 2 (0)
□ 3 or 4 (1)
□ 5 or 6 (2)
□ 7 to 9 (3)
□ 10 or more (4)

3. How often do you have six or more drinks on one occasion?
□ Never (0)
□ Less than Monthly (1)
□ Monthly (2)
□ Two to three times per week (3)
□ Four or more times a week (4)


Add the numerical value of each answer selected to get your total score.

TOTAL SCORE: ______________