Fentanyl Test Questionnaire

1) Where did you get/buy the drugs? (cross streets, i.e. 149Th. St & 3Rd. Ave)
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2) Was it ( ) POSITIVE or ( ) NEGATIVE for traces of Fentanyl?

3) If positive did you use it? () Yes () No

4) If POSITIVE did you use it Differently/how? ( ) Test Shot- ( ) Sniffed Less- ( ) No

Difference
( ) other
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5) How did you use it? ( ) Inject - ( )Snort/Sniff - ( )Smoke

6) What was/is the stamp/brand on the bag?

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7) Is there any other info that you could/want to give us?

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 Cuestionario de prueba de fentanilo

1) Dnde obtuvo / compr los medicamentos? (Cruzar las calles, es decir, 149Th. St y 3Rd
Ave) ______________________________________________________

2) Fue () POSITIVO o (NEGATIVO) para los rastros de Fentanyl?

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3) Lo us? () Si- ()No

4) Si POSITIVO lo utilizaste Diferente / cmo? ( ) Disparo de Prueba- ( ) Olfateado Menos-

() Sin Diferencia ( ) Otro
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5) Cmo lo usaste? ( ) Inyectar - ( ) Snort / Sniff - ( ) Humo

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6) Cul era / es el sello / marca en la bolsa?

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7) Hay alguna otra informacin que pueda / quiera darnos?

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