ALCOHOL INTAKE
Only for screening.
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ALCOHOL CONVERTER: 1 unit of alcohol in UK = 1 measure of spirits, 1/2 pint beer, 1 small glass of wine (125ml) See facing page for conversion guidelines.
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ALCOHOL BREATH TEST
DRUG SCREEN
day month year
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00:00-23:59
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Tick appropriate box(es). Note for each drug the result.
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Note for each drug the result. If any of the drugs are positive, exclude subject from the study.
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