Preface for Screening Questions

These questions help me to provide the

best possible care.

You do not have to answer them if you

are uncomfortable.

I am going to ask you some personal

questions that I ask all my patients.

Screening Questions

Do you smoke? Do you drink? Do you use drugs?

On average, how many days per week do you drink

alcohol ( beer, wine, liquor )?

On a typical day when you drink, how many drinks

do you have?

What is the maximum number of drinks you had on

any given occasion during the last month?

Remember that a “standard drink” consists of:

NIAAA Guidelines: To reduce risk of illness or injury

<14 drinks/week for men and <7 drinks per

week for women

<4 for men & <3 for women in any two hour

drinking occasion

65 years < 3 drinks per occasion

Pregnant women 0 drinks per day