Drug Abuse Data Collection Form

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

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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: