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​​SMART Psyciatric Medical Clearance Form 


  1. Tony W. Thrasher, Martha Rolli, Robert S Redwood, Michael J. Peterson, John Schneider, Lisa Maurer, Michael D. Repplinger. 'Medical Clearance' of Patients With Acute Mental Health Needs in the Emergency Department: A Literature Review and Practice Recommendations Wisconsin Medical Journal. 2019 Dec;118(4):156-163. Print friendly version
  2. S Lam BA, AK Moulin MD. SMART Clearance: A Tool for Medical Clearance in the ED. UC Davis School of Medicine, Sierra Sacramento Valley Medical Society

The following references were used to initially develop the SMART Medical Clearance process.

  1. Aagaard J, Buus N, Wernlund AG, Foldager L, Merinder L. Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room. The International journal of social psychiatry. 2016;62(5):462-470.
  2. Alam A, Rachal J, Tucci VT, Moukaddam N. Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies, Part 2: Special Psychiatric Populations and ConsiderationsThe Psychiatric clinics of North America. 2017;40(3):425-433.
  3. Amin M, Wang J. Routine Laboratory Testing to Evaluate for Medical Illness in Psychiatric Patients in the Emergency Department is Largely UnrevealingWestern Journal of Emergency Medicine 2009;10(2):97-100.
  4. Anderson EL, Nordstrom K, Wilson MP, et al. American Association for Emergency Psychiatry Task Force on Medical Clearance of Adults Part I: Introduction, Review and Evidence-Based Guidelines. The western journal of emergency medicine. 2017;18(2):235-242.
  5. Bentur Y, Lurie Y, Tamir A, Keyes DC, Basis F. Reliability of history of acetaminophen ingestion in intentional drug overdose patients. Human & experimental toxicology. 2011;30(1):44-50.
  6. Biancosino B, Vanni A, Marmai L, et al. Factors Related to Admission of Psychiatric Patients to Medical Wards from the General Hospital Emergency Department: A 3-Year Study of Urgent Psychiatric ConsultationsInternational Journal of Psychiatry in Medicine 2009;39(2):133-46.
  7. Browne V, Knott J, Dakis J, et al. Improving the Care of Mentally Ill Patients in a Tertiary Emergency Department: Development of a Psychiatric Assessment and Planning UnitAustralasian Psychiatry 2011;19(4):350-3.
  8. Chakravarthy B, Menchine M, Thompson DE, Rajeev S, Santos BJ. Psychiatric patient disposition agreement between the emergency physician and the psychiatry consultant. Crisis. 2013;34(5):354-362.
  9. Chang A, Woo BKP. Amphetamine-related Disorders in the Psychiatric Emergency Service (Letter to the Editor)Journal of Emergency Medicine 2014;47(2):61-2.
  10. Chun TH. Medical clearance: time for this dinosaur to go extinct. Annals of emergency medicine. 2014;63(6):676-677.
  11. Corl K, Mello MJ, Baird J, Jagminas L, Siclari M, Kazim A. Variations in laboratory testing during medical clearance of psychiatric patients in the emergency departmentMedicine and health, Rhode Island. 2008;91(11):339-341.
  12. Donofrio JJ, Horeczko T, Kaji A, Santillanes G, Claudius I. Most routine laboratory testing of pediatric psychiatric patients in the emergency department is not medically necessary. Health affairs (Project Hope). 2015;34(5):812-818.
  13. Donofrio JJ, Santillanes G, McCammack BD, et al. Clinical utility of screening laboratory tests in pediatric psychiatric patients presenting to the emergency department for medical clearance. Annals of emergency medicine. 2014;63(6):666-675.e663.
  14. Douglass AM, Luo J, Baraff LJ. Emergency medicine and psychiatry agreement on diagnosis and disposition of emergency department patients with behavioral emergencies. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2011;18(4):368-373.
  15. Downey LA, Zun LS, Gonzales SJ. Utilization of Emergency Department by Psychiatric PatientsPrimary Psychiatry 2009;16(4):60-64.
  16. Drescher MJ, Russell FM, Pappas M, Pepper DA. Can emergency medicine practitioners predict disposition of psychiatric patients based on a brief medical evaluation? European journal of emergency medicine: official journal of the European Society for Emergency Medicine. 2015;22(3):188-191.
  17. Emembolu FN, Zun LS. Medical Clearance in the Emergency Department: Is Testing Indicated? Primary Psychiatry 2010;17(6):29-34.
  18. Fortu JM, Kim IK, Cooper A, Condra C, Lorenz DJ, Pierce MC. Psychiatric patients in the pediatric emergency department undergoing routine urine toxicology screens for medical clearance: results and use. Pediatric emergency care. 2009;25(6):387-392.
  19. Guidelines APASCoP. Psychiatric evaluation of adults, a quick reference guide. American Psychiatric Association Practice Guidelines. 2006:1-18.
  20. Gregory RJ, Nihalani ND, Rodriguez E. Medical Screening in the Emergency Department for Psychiatric Admissions: A Procedural Analysis. General Hospital Psychiatry 2004;26(5):405-10.
  21. Hack JB, Goldlust EJ, Gibbs F, et al. The H-Impairment Index (HII): a standardized assessment of alcohol-induced impairment in the Emergency Department. The American Journal of Drug and Alcohol Abuse 2014;40(2):111-7.
  22. Hall RC, Gardner ER, Popkin MK, Lecann AF, Stickney SK. Unrecognized physical illness prompting psychiatric admission: a prospective study. The American journal of psychiatry. 1981;138(5):629-635.
  23. Hall RC, Gardner ER, Stickney SK, LeCann AF, Popkin MK. Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population. Archives of general psychiatry. 1980;37(9):989-995.
  24. Henneman PL, Mendoza R, Lewis RJ. Prospective evaluation of emergency department medical clearance. Annals of emergency medicine. 1994;24(4):672-677.
  25. Hollander JE, McCracken G, Johnson S, Valentine SM, Shih RD. Emergency department observation of poisoned patients: how long is necessary? Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1999;6(9):887-894.
  26. Janiak BD, Atteberry S. Medical Clearance of the Psychiatric Patient in the Emergency DepartmentJournal of Emergency Medicine 2012;43(5):866-70.
  27. Korn CS, Currier GW, Henderson SO. “Medical Clearance” of Psychiatric Patients without Medical Complaints in the Emergency DepartmentJournal of Emergency Medicine 2000;18(2):173-6.
  28. Kroll DS, Smallwood J, Chang G. Drug Screens for Psychiatric Patients in the Emergency Department: Evaluation and RecommendationsPsychosomatics 2013;54(1):60-6.
  29. Lindor RA, Campbell RL, Pines JM, et al. EMTALA and patients with psychiatric emergencies: a review of relevant case law. Annals of emergency medicine. 2014;64(5):439-444.
  30. Lucanie R, Chiang WK, Reilly R. Utility of acetaminophen screening in unsuspected suicidal ingestions. Veterinary and human toxicology. 2002;44(3):171-173.
  31. Lukens TW, Wolf SJ, Edlow JA, et al. Clinical Policy: Critical issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency DepartmentAnnals of Emergency Medicine 2006;47:79-99.
  32. Olshaker JS, Browne B, Jerrard DA, Prendergast H, Stair TO. Medical clearance and screening of psychiatric patients in the emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 1997;4(2):124-128.
  33. Parmar P, Goolsby CA, Udompanyanan K, Matesick LD, Burgamy KP, Mower WR. Value of mandatory screening studies in emergency department patients cleared for psychiatric admission. The western journal of emergency medicine. 2012;13(5):388-393.
  34. Pinto T, Poynter B, Durbin J. Medical clearance in the psychiatric emergency setting: a call for more standardization. Healthcare quarterly (Toronto, Ont). 2010;13(2):77-82.
  35. Pomerleau AC, Sutter ME, Owen KP, et al. Amphetamine Abuse in Emergency Department Patients Undergoing Psychiatric EvaluationJournal of Emergency Medicine 2012;43(5):798-802.
  36. Puskar K, Smith MD, Herisko C, Urda B. Medical emergencies in psychiatric hospitalsIssues in mental health nursing. 2011;32(10):649-653.
  37. Reeves RR, Parker JD, Burke RS, Hart RH. Inappropriate psychiatric admission of elderly patients with unrecognized delirium. Southern medical journal. 2010;103(2):111-115.
  38. Reeves RR, Parker JD, Loveless P, Burke RS, Hart RH. Unrecognized physical illness prompting psychiatric admission. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists. 2010;22(3):180-185.
  39. Reeves RR, Pendarvis EJ, Kimble R. Unrecognized medical emergencies admitted to psychiatric units. The American journal of emergency medicine. 2000;18(4):390-393.
  40. Riba M, Hale M. Medical clearance: fact or fiction in the hospital emergency roomPsychosomatics. 1990;31(4):400-404.
  41. Santillanes G, Donofrio JJ, Lam CN, et al. Is Medical Clearance Necessary for Pediatric Psychiatric Patients? Journal of Emergency Medicine 2014;46(6):800-7.
  42. Schauer SG, Goolsby CA. A Retrospective Review of Screening Labs for Medical Clearance in a Military PopulationMilitary medicine. 2015;180(11):1128-1131.
  43. Shah SJ, Fiorito M, McNamara RM. A Screening Tool to Medically Clear Psychiatric Patients in the Emergency DepartmentJournal of Emergency Medicine 2012;43(5):871-5.
  44. Schiller MJ, Shumway M, Batki SL. Utility of Routine Drug Screening in a Psychiatric Emergency SettingPsychiatric Services 2000;51(4):474-8.
  45. Shihabuddin BS, Hack CM, Sivitz AB. Role of urine drug screening in the medical clearance of pediatric psychiatric patients: is there one? Pediatric emergency care. 2013;29(8):903-906.
  46. Sporer KA, Khayam-Bashi H. Acetaminophen and salicylate serum levels in patients with suicidal ingestion or altered mental status. The American journal of emergency medicine. 1996;14(5):443-446.
  47. Szpakowicz M, Herd A. “Medically Cleared”: How Well are Patients with Psychiatric Presentations Examined by Emergency PhysiciansJournal of Emergency Medicine 2008;35(4):369-72.
  48. Tolia V, Wilson MP (2013). The Medical Clearance Process for Psychiatric Patients Presenting Acutely to the Emergency Department. In L Zun, L Chepenik & MN Mallory (Eds.), Behavioral Emergencies for the Emergency Physician (pp. 19-24). New York, NY: Cambridge University Press.
  49. Tucci V, Siever K, Matorin A, Moukaddam N. Down the Rabbit Hole: Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies. Emergency medicine clinics of North America. 2015;33(4):721-737.
  50. Williams ER, Shepherd SM. Medical clearance of psychiatric patients. Emergency medicine clinics of North America. 2000;18(2):185-198, vii.
  51. Wilson MP, Nordstrom K, Anderson EL, et al. American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations. The western journal of emergency medicine. 2017;18(4):640-646.
  52. Wolf SJ, Lo B, Shih RD, et al. Clinical Policy: Critical issues in the Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood PressureAnnals of Emergency Medicine 2013;62:59-68.
  53. Wrenn G. One more reason to ban “medical clearance” for psychiatric evaluation? Annals of emergency medicine. 2015;65(5):619-620.
  54. Yun BJ, Chou SC, Nagurney JM, White BA, Wittmann CW, Raja AS. ED utilization of medical clearance testing for psychiatric admission: National Hospital Ambulatory Medical Care Survey analysis. The American journal of emergency medicine. 2017.
  55. Zun LS. Evidence Based Evaluation of Psychiatric PatientsJournal of Emergency Medicine 2005;28(1):35-9.
  56. Zun LS, Leikin JB, Stotland NL, Blade L, Marks RC. A tool for the emergency medicine evaluation of psychiatric patients. The American journal of emergency medicine. 1996;14(3):329-333.
  57. Zun LS, Downey L. Application of a Medical Clearance ProtocolPrimary Psychiatry 2007;14:47-51.