“Medical clearance” has been used as an umbrella term, and is often why mental health patients are referred to the Emergency Department. However, this terminology refers to several different concepts. The idea of a “one size fits all” checklist for medical clearance is not realistic. Mental health patients run the gamut from acute medical conditions to non-acute co-morbid conditions. Ultimately, screening needs to determine if the patient is stable for transfer to follow on mental health treatment. The emergency department can also be the point of entry to a collaborative care model. Let’s explore some patient examples and talk about what is really needed.