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Modified Simple Screening Instrument for Substance Abuse MSSI-SA Scoring Sheet Name/ID No Date Place/Location Name of Clinician Completing Screen Items 1 and 15 are not scored. The following items are scored as 1 yes or 0 no 2 7 3 8 4 9 5 any items listed 10 16 11 Total score Score range 0-14 Preliminary interpretation of responses Score Degree of Risk for Substance Abuse 0-1.

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