Problem & Purpose: Early identification of Alpha-1 Antitrypsin Deficiency (AATD) could prevent widespread pathological destruction of the lung parenchyma, possibly delaying time to death. On average AATD patients experience a diagnostic delay of six years and have to consult three physicians until diagnosis is established. With the implementation of established guidelines, unidentified individuals at risk for AATD may be identified and treated earlier to prevent premature death. The purpose of this quality improvement project is to implement a clinical practice guideline-based screening tool to identify at-risk patients for AATD at a rural primary care practice where the patient population is at risk. Methods: An evidence –based screening tool was administered for every patient with an appointment at the primary care practice. Patients who met inclusion criteria based upon personal or family medical history were screened for AATD using an evidenced-based tool during routine provider visits. Patient’s found to be at-risk with a were offered testing for AATD in the practice. Results: A total of 235 patients were screened over 12 weeks with an overall screening rate of 96.8% after implementation of the screening tool. 11% of patients screened were found to be atrisk for AATD, 35% were male and 65% were female. There was no difference between gender and being at-risk, p <.0005. Conclusion: Improvements of identifying patients at risk for AATD were accomplished by implementing staff education as well as paper evidenced-based screening tools during each appointment resulting in with 11% positive results.