Substance Use Disorder Audit Form
Use this form to record a structured audit of substance use disorder screening, documentation, and follow-up readiness. The form title must remain exactly "Substance Use Disorder Audit Form" throughout.
Audit Overview
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Audited Program / Location / Department
*
Audit Type
*
Please Select
Initial Audit
Routine Review
Follow-Up Review
Spot Check
Auditor Name or Team
*
Program Review Details
Setting or Service Area Audited
*
Outpatient
Inpatient
Residential
Intensive Outpatient
Other
Review Period Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Review Period End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Documentation Completeness
*
Complete
Partially Complete
Incomplete
Audit Findings and Follow-Up
Overall audit result
*
Pass
Needs improvement
Critical issue
Primary finding summary
*
Recommended follow-up action or next step
Submit
Should be Empty: