Resource Center: checklist

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Michigan Alcoholism Screening Test (MAST)

Description: 
The Michigan Alcoholism Screening Test (MAST) is a 25-item questionnaire used to screen for alcohol abuse and dependence.

1. Do you enjoy a drink now and then? (Introductory -- no points)
2. Do you feel you are a normal drinker (by normal, we mean do you drink less than or as much as most other people)? (2)

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The Mood Disorder Questionnaire
Description: 
The mood disorder questionnaire consists of five yes or no questions to be completed by the patient. The MDQ was developed by a team of psychiatrists, researchers and consumer advocates to address a critical need for timely and accurate diagnosis of bipolar disorder, which can be fatal if left untreated. The questionnaire takes about five minutes to complete, and can provide important insights into diagnosis and treatment.
Source: 
Depression and Bipolar Support Alliance
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Infant/child family history questionnaire
Description: 
This is a comprehensive, paper-based screening form from the March of Dimes that includes a child's past medical history, pregnancy and birth history, and maternal and paternal family histories for a lengthy list of potentially inherited conditions, as well as a place for office notes regarding significant findings and plans.
Source: 
March of Dimes
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Preconception/prenatal family history questionnaire
Description: 
This is a comprehensive, paper-based screening form from the March of Dimes that includes past medical history, exposures history, reproductive history, and extended family history for a lengthy list of potentially inherited conditions, as well as a place for office notes regarding significant findings and plans.
Source: 
March of Dimes
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