AUDIT-C Alcohol Screening

Administer and score the validated three-question AUDIT-C instrument to identify risky alcohol use patterns, calculate the composite score, and document the corresponding risk zone for clinical follow-up.

Participant & Screening Context

• Participant Full Name
• Employee / Patient ID
  Enter only if required by your organization's intake process.
• Screening Date
• Screening Context
  Select the setting or reason this screening is being conducted.
• Administering Clinician / Screener Name
• Participant Consent
  The participant has been informed that their responses are confidential, used solely for health screening purposes, and handled in accordance with applicable privacy regulations (HIPAA / organizational policy). Responses will not be used for disciplinary action unless required by law.

AUDIT-C Questions

• Q1 — How often do you have a drink containing alcohol?
  Select the response that best describes the participant's drinking frequency over the past 12 months. (AUDIT-C Item 1 — scored 0–4)
• Q2 — How many standard drinks containing alcohol do you have on a typical day when you are drinking?
  A standard drink = 12 oz regular beer, 5 oz wine, or 1.5 oz distilled spirits. (AUDIT-C Item 2 — scored 0–4)
• Q3 — How often do you have 6 or more drinks on one occasion?
  Heavy episodic (binge) drinking indicator. (AUDIT-C Item 3 — scored 0–4)

Scoring & Risk Zone

• Total AUDIT-C Score (0–12)
  Enter the sum of Q1 + Q2 + Q3. Verify against individual question values above.
• Biological Sex (for risk threshold interpretation)
  AUDIT-C risk thresholds differ by biological sex per SAMHSA and VA/DoD clinical guidelines. This field is used solely for scoring interpretation.
• Risk Zone
  Select the risk zone based on total score and biological sex thresholds. If 'Not disclosed', apply the more conservative (female) thresholds.
• Non-Drinker / Score = 0 Confirmation
  If total score is 0, confirm whether the participant is a non-drinker or declined to answer.

Clinical Notes & Next Steps

• Contextual / Clinical Notes
  Optional. Do not record unrelated PII. Limit to clinically relevant observations.
• Recommended Next Step
  Select the primary action to be taken following this screening.
• Follow-Up Date
  If a follow-up appointment or re-screening is planned, record the target date.
• Referral Resource / Contact
  Record the specific resource or contact provided to the participant.
• Clinician Signature
  By signing, the clinician certifies that the AUDIT-C was administered as documented and that the recorded score and risk zone are accurate.