Alcohol Abuse Scale
CAGE-AID
Date Of Exam:
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Patient Name:
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First Name
Last Name
Date of Birth
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When doing this form please think about:
This is a list of questions concerning information for your potential involvement with Alcohol.
Have you ever felt you ought to cut down on your drinking?
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Yes
No
Have people annoyed you by criticizing your drinking?
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Yes
No
Have you felt bad or guilty about your drinking?
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Yes
No
Have you ever had a drink first thing in the morning to steadyyour nerves or to get rid of a hangover (eye-opener)?
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Yes
No
Submit
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