DAST-10 Drug Use Screening and Follow-Up Form
Use this DAST-10 Drug Use Screening and Follow-Up Form to record screening context, capture the 10 responses, calculate the total score, and document next steps in one place.
Trusted by frontline teams 15 years of frontline software AI customization in seconds
Built for: Behavioral Health · Primary Care · Occupational Health · Employee Assistance Programs
Overview
This DAST-10 Drug Use Screening and Follow-Up Form is built to document a single screening event from start to finish: the screening date, who administered it, the setting, whether consent was obtained, the 10 DAST responses, the total score, the risk level, and any follow-up actions. It is designed for workflows where a structured screen needs to be scored consistently and then handed off for next steps without relying on a free-text note.
Use this template when you need a repeatable record for intake, periodic reassessment, referral triage, or follow-up after a concern is raised. It is especially useful when multiple staff members may review the result and need the same fields in the same order. The form also helps keep the record focused on the minimum necessary information, which matters when handling sensitive health data.
Do not use this template as a substitute for a full clinical assessment, diagnosis, or treatment plan. If your setting does not require a formal DAST-10 screen, or if you only need a general wellness check without scoring, a lighter intake form may be a better fit. The goal here is structured screening plus clear follow-up, not broad substance-use history collection.
Standards & compliance context
- Because this form collects sensitive health information, limit fields to the minimum necessary and document consent or disclosure before screening.
- Use an audit trail or equivalent record history when the form is part of a clinical workflow so changes to scores and follow-up actions are traceable.
- If the form is used in an accessibility-sensitive environment, keep labels, validation messages, and navigation aligned with WCAG 2.1 AA expectations.
- For any intake or accommodation workflow, avoid collecting more PII than needed and use progressive disclosure for follow-up questions.
General regulatory context for orientation only — verify current requirements with counsel or the relevant agency before relying on this template for compliance.
What's inside this template
Screening Context
This section matters because it records who administered the screen, where it happened, and whether consent was obtained before any sensitive questions were asked.
- Screening Date
-
Administered By
Name or role of the person administering the screening.
- Screening Setting
-
Consent / disclosure provided before screening
Confirm that the purpose of the screening and any PII collection were explained before the form was completed.
DAST-10 Responses
This section matters because the individual item responses are the source data for the score and should be captured in the exact order of the instrument.
- 1. Have you used drugs other than those required for medical reasons?
- 2. Do you abuse more than one drug at a time?
- 3. Are you always able to stop using drugs when you want to?
- 4. Have you had blackouts or flashbacks as a result of drug use?
- 5. Do you ever feel bad or guilty about your drug use?
- 6. Does your spouse, parent, or other close relative ever complain about your involvement with drugs?
- 7. Have you neglected your family because of your use of drugs?
- 8. Have you engaged in illegal activities in order to obtain drugs?
- 9. Have you ever experienced withdrawal symptoms when you stopped taking drugs?
- 10. Have you had medical problems as a result of your drug use?
Scoring and Risk Level
This section matters because it turns the responses into a documented score and risk level that other staff can review consistently.
-
Total DAST-10 Score
Enter the total score from 0 to 10.
- Risk Level
-
Screening Summary
Brief clinical interpretation of the result, including any relevant observations.
Follow-Up Actions
This section matters because a screening only helps if the next step is assigned, documented, and easy to track after submission.
- Follow-up required?
- Recommended Follow-Up Actions
-
Follow-Up Notes
Document referrals, counseling provided, patient response, and any next appointment or handoff details.
How to use this template
- 1. Set the screening context by entering the date, the staff member administering the form, the screening setting, and whether consent was obtained.
- 2. Record each DAST-10 response using the correct field type and keep the answers in the same order as the instrument.
- 3. Calculate and enter the total score, then assign the risk level according to your organization’s scoring rules or clinical protocol.
- 4. Write a short screening summary that explains the result in plain language and flags any immediate concerns that need attention.
- 5. Mark whether follow-up is needed, assign the next action and owner, and document any referral, outreach, or safety step in the follow-up notes.
Best practices
- Use a date picker for the screening date and structured response fields for the DAST items so the record is easy to score and review.
- Mark only the truly required fields as required, and keep optional fields optional to avoid forcing staff to collect unnecessary PII.
- Add conditional logic so follow-up actions appear only when follow_up_needed is selected, which keeps the form shorter and easier to complete.
- Document consent before the screening begins, especially when the form may be used in a setting where the result becomes part of a shared record.
- Keep the screening summary brief and factual, and avoid diagnostic language unless a qualified clinician has made that determination.
- Assign a clear owner for every follow-up action so the result does not sit in the record without a next step.
- Review the scoring rules with every staff member who administers the form so the total score and risk level are applied consistently.
What this template typically catches
Issues teams running this template most often surface in practice:
Common use cases
Frequently asked questions
Who should use this DAST-10 form?
This template is for clinicians, behavioral health staff, occupational health teams, and other authorized screeners who need a structured drug-use screening record. It works best when a trained staff member administers the DAST-10 and documents the score and follow-up in the same workflow. It is not a self-diagnosis tool. If you need a patient-facing intake form, use a separate intake template with clearer consent and privacy language.
What does this template cover, and what does it not cover?
It covers screening context, the 10 DAST items, total score, risk level, screening summary, and follow-up actions. It does not replace a full clinical assessment, diagnosis, or treatment plan. Use it as a screening and documentation tool, then route higher-risk results to the appropriate clinician or referral path. If you need broader substance-use history, add only the fields you will actually use.
How often should the DAST-10 be administered?
Use it when screening is clinically indicated, at intake, during periodic reassessment, or when a policy requires follow-up after a concern is raised. The right cadence depends on your setting and workflow, not the form itself. Avoid repeating it so often that it becomes redundant or burdensome without changing care decisions. If you run recurring screenings, keep the same scoring rules and review process each time.
What should be included in the follow-up section?
Document whether follow-up is needed, what action was taken, who is responsible, and any referral or safety steps. Keep the notes focused on the minimum necessary information, especially if the record may be shared across teams. If the result is elevated, include the next clinical step rather than vague language like "monitor." Clear follow-up fields make the form useful after the screening is over.
Are there privacy or consent concerns with this form?
Yes. Drug-use screening can involve sensitive health information, so the form should capture consent obtained and limit collection to what is needed for the screening and follow-up. If your workflow allows anonymous submission, use it only when identification is not required for care or audit trail purposes. Make sure the user understands what happens after submission and who can access the record.
What are the most common mistakes when using a DAST-10 form?
Common mistakes include leaving required fields unclear, mixing up item responses, skipping the total score, and documenting follow-up without assigning ownership. Another frequent issue is collecting extra PII that is not needed for the screening. The form should also avoid free-text substitutes for structured responses when a fixed option or numeric field is more accurate. A clean workflow reduces scoring errors and follow-up gaps.
Can this template be customized for different settings?
Yes. You can adapt the screening setting field, add conditional logic for referral pathways, and tailor follow-up actions to primary care, behavioral health, occupational health, or employee assistance workflows. Keep the DAST-10 items and scoring logic intact if you want comparable results over time. If you add local policy fields, make them optional unless they are truly required for your process.
How does this compare with an ad hoc note or free-text intake?
A structured template is easier to score, review, and audit than a free-text note. It reduces missed items, supports consistent follow-up, and makes it clearer what happened after the screening. Free-text can hide key details like consent, risk level, or responsibility for next steps. Use this template when you need repeatable documentation rather than an informal conversation record.
Related templates
Go deeper on the topic
-
Lockout/tagout (LOTO) is the procedure for controlling hazardous energy — electrical, hydraulic, pneumatic, mechanical, thermal, chemical — before...
-
Job hazard analysis (JHA) — also called job safety analysis (JSA) — is the structured exercise of breaking a work task into sequential steps, identifying the...
-
A near-miss is an event that could have caused injury or damage but didn't — a slip that didn't fall, a load that shifted but didn't drop, a machine that...
-
AI governance is the framework a company uses to decide what AI tools are allowed to do, who's accountable for their outputs, what data they're allowed to...
-
Learn how AI-driven workflows close compliance gaps in hiring, field inspections, and compensation — before they become audit findings.
-
Spring '26 adds real-time Google & Outlook calendar sync, Google Workspace file creation in Files, upgraded Messenger, and expanded mobile parity.
-
Learn how nonprofit tracking of KPIs, donations, and operational workflows reduces turnover and improves decision-making with the right knowledge management...
-
Compare the best employee apps of 2026—MangoApps, Blink, WorkJam, Flip, and more—to find the right fit for your frontline workforce.
Ready to use this template?
Get started with MangoApps and use DAST-10 Drug Use Screening and Follow-Up Form with your team — pricing built for small business.
