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Prescreen Form
Prescreen Form

These 3 questions are used to prescreen patients to determine if a full screen is necessary. Question 1 screens for alcohol use (taken from the AUDIT-10); Question 2 screens for illicit drug use (taken from the DAST-10); Question 3 is optional, and screens for depression (taken from the PHQ-9).

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IU School of Public Health Bloomington         IPRC: Indiana Prevention Resource Center         SAMHSA