The Veterans Health Administration (VHA) has successfully implemented evidence- based alcohol misuse screening with the AUDIT-C. The purpose of this study was to evaluate clinical alcohol screening during the first year after implementation. Using medical record review and mailed patient surveys collected during 2004 by VHA Office of Quality and Performance, this study analyzed concordance of screening results among patients with AUDIT-Cs in both data sources. Among 1,637 patients with AUDIT-C from both sources within 90 days, the medical record screening prevalence rate of alcohol misuse, 24.6% (95% CI: 22.5% to 26.7%), was significantly lower than the survey rate, 33.4% (31.1% to 35.7%). Of 8,312 patients identified as nondrinkers in medical records, 24% reported past year alcohol use and 5% screened positive for alcohol misuse on surveys. Lower rates of alcohol use and misuse documented in medical records compared to mailed surveys suggest further investigation and standardization of clinical screening are necessary.