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Run: SBIRT Screening Documentation

SBIRT Screening Documentation captures the screening result, brief intervention, and referral-to-treatment details in one place. Use it to document early int...

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Consent, Privacy, and Submission Notice

What happens after I submit?

Consent to document screening and intervention (required)

Yes No N/A

Privacy and information-sharing disclosure acknowledged (required)

Yes No N/A

Encounter Details

Encounter date (required)

Encounter time

Service setting (required)

Reason for screening (required)

Screening tool used (required)

Screening Results

Substances screened (required)

Overall screening result (required)

Alcohol screening score

Drug screening score

Screening notes

Document only clinically relevant observations. Avoid unnecessary PII.

Brief Intervention

Brief intervention delivered (required)

Yes No N/A

Intervention type (required)

Readiness to change

Brief intervention summary (required)

Referral to Treatment

Referral needed (required)

Referral type

Referral destination

Enter the program, clinic, or service name only. Avoid unnecessary identifiers.

Referral contact method

Follow-up date

Disposition and Follow-Up

Disposition (required)

Follow-up plan

Additional comments

Document only information necessary for care coordination and the audit trail.

Get your results

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Email (required)

Your name (optional)

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