Patients with alterations in mental status must receive an appropriate medical diagnostic workup. Any abnormal vital signs must be addressed and should normalize within a 24-hour stay if due to anxiety. History and physical examination is critical, including medication history. Testing should be guided by the history and physical examination findings. No single battery of tests will pick up every metabolic or structural abnormality that might affect patient behavior. Universal laboratory and toxicologic screening of all patients with psychiatric complaints has a low yield and generally does not affect care. It is desirable to coordinate protocols for screening with the desires and needs of one’s psychiatric service. The term “medical clearance” cannot ensure that a patient is indeed clear of all medical conditions. Some have argued against using the phrase “medically clear” as this can minimize the presence of underlying medical problems. Instead the American Association for Emergency Psychiatry advocates for stating patients are “medically stable,” which implies the patient has received a thorough medical examination and their current behavior disturbance is not likely due to a medical or traumatic cause.