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Raise the subject 
1. Ask the patient for permission to discuss their health and wellness 
questionnaire, including alcohol and drug use (AOD). 
Provide feedback 
2. Review patients AOD patterns & risk level. 
3. Express concern about patients use patterns & risk level. 
4. Ask about pros and cons of AOD use. 
5. Summarize and restate in patients own words. 
6. Provide medical facts and information that there is a connection 
between AOD and negative consequences. 
7. Compare screening responses to NIAAA low risk AOD guidelines. 
Enhance motivation 
8. Ask patient to identify readiness to change on the Readiness Ruler 
tool and ask why they chose that number and not a lower one. 
9. Elicit other reasons for changing. 
10. Identify strengths and supports. 
Negotiate a plan 
11. Negotiate the goal (What would you like to do?). 
12. Summarize (This is what Ive heard you say . . .). 
13. Have patient write out the change plan, if appropriate. 
14. Provide Health Information handout. 
15. Suggest Primary Care or other follow-up as needed. 
Brief Negotiated Interview Provider Checklist 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
oYes oNo 
Medicaid Billing Codes 
99408 - AOD screening/BI (1529 min.) 
99409 - AOD screening/BI (30+ min.) 
healthvermont.gov  sbirt.vermont.gov  802-225-6066 
Adapted from: 
Miller, Rollnick, DOnofrio, Bernstein 
Boston University School of Public Health 
Yale School of Medicine

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Bni checklist-10-2-14

  • 1. Raise the subject 1. Ask the patient for permission to discuss their health and wellness questionnaire, including alcohol and drug use (AOD). Provide feedback 2. Review patients AOD patterns & risk level. 3. Express concern about patients use patterns & risk level. 4. Ask about pros and cons of AOD use. 5. Summarize and restate in patients own words. 6. Provide medical facts and information that there is a connection between AOD and negative consequences. 7. Compare screening responses to NIAAA low risk AOD guidelines. Enhance motivation 8. Ask patient to identify readiness to change on the Readiness Ruler tool and ask why they chose that number and not a lower one. 9. Elicit other reasons for changing. 10. Identify strengths and supports. Negotiate a plan 11. Negotiate the goal (What would you like to do?). 12. Summarize (This is what Ive heard you say . . .). 13. Have patient write out the change plan, if appropriate. 14. Provide Health Information handout. 15. Suggest Primary Care or other follow-up as needed. Brief Negotiated Interview Provider Checklist oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo oYes oNo Medicaid Billing Codes 99408 - AOD screening/BI (1529 min.) 99409 - AOD screening/BI (30+ min.) healthvermont.gov sbirt.vermont.gov 802-225-6066 Adapted from: Miller, Rollnick, DOnofrio, Bernstein Boston University School of Public Health Yale School of Medicine