Drug Abuse Data Collection Form

Date:
County:
Name of Court:
Judge's Name:
Type of Docket:
Active Participants (1-999):

-

Participants testing positive by drug of abuse.   Enter a percent ##.# with one decimal place for each category listed below:

Marijuana:
Cocaine:
Prescription Opiates:
Heroin:
Fentanyl and Analogs:
Methamphetamines:
Benzodiazepines:
Other:
Recaptcha Word Verification: