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Run: SBIRT Screening Documentation

SBIRT Screening Documentation captures the screening result, brief intervention, and referral plan in one clinical record. Use it to document early intervent...

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Consent, Privacy, and Submission Notice

Submission context (required)

Consent to document screening and intervention (required)

Confirm that the individual was informed about the purpose of this documentation and any applicable privacy practices before collecting PII.

Yes No N/A

Privacy notice acknowledged (required)

Acknowledge that only minimum-necessary data should be recorded and shared according to policy and applicable law.

Yes No N/A

What happens after I submit

After submission, the documentation is saved to the audit trail, visible to authorized care team members, and used to support follow-up, referral, or treatment planning.

Client and Encounter Details

Client or patient identifier (required)

Use the organization’s internal identifier when possible. Avoid collecting SSN or other unnecessary sensitive identifiers.

Encounter date (required)

Encounter location

Screening tool used (required)

Substance Use Screening Results

Screening result (required)

Substance categories identified

Screening score

Enter the score only if the selected tool produces a numeric score.

Screening notes

Include only clinically relevant observations. Avoid unnecessary PII.

Brief Intervention

Brief intervention provided (required)

Yes No N/A

Intervention method

Intervention duration (minutes)

Patient response

Referral to Treatment and Follow-Up

Referral to treatment needed (required)

Referral type

Referral urgency

Follow-up plan

Document next steps, responsible party, and any scheduled follow-up contact.

Clinician Attestation

Clinician name (required)

Clinician role

Documentation complete and accurate (required)

Confirm the record is complete, accurate, and limited to minimum-necessary information.

Yes No N/A

Clinician signature (required)

Get your results

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Email (required)

Your name (optional)

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