Use our readymade template to create your AUDIT screening tool for alcohol use disorders
Create your care assessments
| AUDIT score | Diagnosis | Proposed treatment |
|---|---|---|
| 0 | Abstainer | No treatment |
| 1-7 | Low-risk consumption | Advice on reducing alcohol consumption |
| 8-14 | Hazardous or harmful alcohol consumption | Brief counseling and continued monitoring |
| 15-19 | Moderate-severe alcohol use disorder | Referral to specialist for diagnostic evaluation and treatment |
| 20-40 | Severe alcohol use disorder | Referral to specialist for diagnostic evaluation and treatment |
- Prebuilt template with AUDIT scoring to assess the presence of alcohol use disorders and measure its severity
- 10-item questionnaire that scores each item on a scale of 0 to 4
- Real-time calculation of AUDIT Score and diagnosis based on the form responses
- Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
- Compare the scores from the initial screening with that of the followup to track the progression of alcohol use disorders
- Easily create responsive forms that allow patients to complete their assessments on any device at any time
Collect responses from your patients
| Patient ID | 1004 |
| Patient Name | John W |
| Patient Email | johnw@ymail.com |
| Patient Phone Number | 0987654321 |
| Doctor's Name | Dr. Smith |
| Location | New York |
| How often do you have a drink containing alcohol? | 2-3 times a week |
| How many standard drinks containing alcohol do you have on a typical day when drinking? | 3 or 4 |
| How often do you have six or more drinks on one occasion? | Monthly |
| During the past year, how often have you found that you were not able to stop drinking once you had started? | Less than monthly |
| During the past year, how often have you failed to do what was normally expected of you because of drinking? | Never |
| During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session? | Never |
| During the past year, how often have you had a feeling of guilt or remorse after drinking? | Less than monthly |
| During the past year, how often have you been unable to remember what happened the night before because you had been drinking? | Never |
| Have you or someone else been injured as a result of your drinking? | No |
| Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down? | No |
| AUDIT Score | 8 |
| Diagnosis | Hazardous or harmful alcohol consumption |
- Pre-populate patient details such as patient id, name, email etc in the AUDIT assessment form before sharing it with the patients
- Send an email invitation with a secure link for patients to complete their AUDIT assessment form prior to their visit
- Allow patients to save their progress and complete their AUDIT assessment form at a later time without losing any responses
- Set up an email template for your AUDIT assessment and automatically send invitation emails to multiple patients with ease
- Send a confirmation email to the patients with their AUDIT score, diagnosis, next steps when they submit their AUDIT assessment
Track patient responses in Google Sheets
| A | B | C | D | E | |
|---|---|---|---|---|---|
| 1 | Name | Question | Answer | Score | Total Score |
| 2 | John W | How often do you have a drink containing alcohol? | 2-3 times a week | 3 | 8 |
| 3 | John W | How many standard drinks containing alcohol do you have on a typical day when drinking? | 3 or 4 | 1 | 8 |
| 4 | John W | How often do you have six or more drinks on one occasion? | Monthly | 2 | 8 |
| 5 | John W | During the past year, how often have you found that you were not able to stop drinking once you had started? | Less than monthly | 1 | 8 |
| 6 | John W | During the past year, how often have you failed to do what was normally expected of you because of drinking? | Never | 0 | 8 |
| 7 | John W | During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session? | Never | 0 | 8 |
| 8 | John W | During the past year, how often have you had a feeling of guilt or remorse after drinking? | Less than monthly | 1 | 8 |
| 9 | John W | During the past year, how often have you been unable to remember what happened the night before because you had been drinking? | Never | 0 | 8 |
| 10 | John W | Have you or someone else been injured as a result of your drinking? | No | 0 | 8 |
| 11 | John W | Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down? | No | 0 | 8 |
- Export patient responses including the calculated AUDIT score and diagnosis to Google Sheets for easy record-keeping
- Export individual points for 10 items to Google Sheets for data manipulation and analysis for comprehensive insights
- Use pre-built reports to easily keep track of patient progress over time and monitor changes in their alcohol use patterns
- Receive a copy of the response and the calculated AUDIT score by email whenever a patient submits their AUDIT assessment
- Use data in Google Sheets to integrate with external EHR systems for seamless data transfer
HIPAA compliance
| Patient ID: | 1004 |
| Patient Name: | ****** |
| Patient Email: | ****** |
| Patient Phone Number: | ****** |
| Doctor's Name: | Dr. Smith |
| Location: | New York |
| How often do you have a drink containing alcohol? : | 2-3 times a week |
| How many standard drinks containing alcohol do you have on a typical day when drinking?: | 3 or 4 |
| How often do you have six or more drinks on one occasion?: | Monthly |
| During the past year, how often have you found that you were not able to stop drinking once you had started?: | Less than monthly |
| During the past year, how often have you failed to do what was normally expected of you because of drinking?: | Never |
| During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?: | Never |
| During the past year, how often have you had a feeling of guilt or remorse after drinking?: | Less than monthly |
| During the past year, how often have you been unable to remember what happened the night before because you had been drinking?: | Never |
| Have you or someone else been injured as a result of your drinking?: | No |
| Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?: | No |
| AUDIT Score: | 8 |
| Diagnosis: | Hazardous or harmful alcohol consumption |
| AUDIT Score: | 8 |
| Diagnosis: | Hazardous or harmful alcohol consumption |
- Create a HIPAA compliant AUDIT assessment form to safely collect, store and access patient responses
- Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
- Automatically mask PHI fields when exporting AUDIT form responses to Google Sheets and sending them on email
- Prepopulate patient details in AUDIT assessments by creating secure prefill links without exposing PHI
- Limit access to patient data only for authorized personnel and minimize the risk of data breaches
These reviews are reproduced without modification from Google Workspace Marketplace.
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