---
title: "Medical Clearance"
url: https://mghmclean.org/residents/handbk/part2a/med.htm
description: "Medical clearance is done by APS with consultation as needed from the medical/surgical teams. Goal is to state confidently that the patient has no acute medical issues and is..."
published: 2026-08-10
updated: 2026-08-10
---

# Medical Clearance

Published 2026-08-10

PART 3 / CH 16

Marion Eakin

**Medical clearance** is done by APS with consultation as needed from the medical/surgical teams. Goal is to state confidently that the patient has no acute medical issues and is stable for transfer to an inpatient psychiatric unit. This is *not*the time to work up chronic complaints.

## Key elements include:

1. **PMHx and ROS**:

a. which organ systems to focus on in the physical exam

b. any history of head trauma, seizure or DT’s

c. lab tests to order

d. need for further work-up, such as EKG or imaging.

2. Screening physical exam (adults):

| System | Assess for |
|---|---|
| VS | evidence of intoxication/withdrawal |
| Skin | track marks, rash reactions to meds, signs of self-mutilation |
| HEENT | dilated/constricted pupils, nystagmus |
| Neck | stiffness, thyromegaly/nodules |
| Chest | reactive airway flare, hyperventilation |
| Neuro | ataxia, tremor, focal deficits |

· MGH pediatrics residents expect to be called for exams on patients up to age 18. Use your own comfort level for ages 13-18.

· Labs are rarely required for child psychiatric admissions; one exception is bHCG for all females of reproductive age. Other indications: overdose, substance abuse history, comorbid medical issues, valproate/ Li levels

## 3. Routine admission labs:

| Lab | Notes |
|---|---|
| CBC | with differential if on clozapine |
| Chem 7 |  |
| b-HCG | ALL women of reproductive age |
| Urine Tox | good for recent cocaine, marijuana, amphet. |
| Serum Tox | basic panels for most psych admits, complete screen for history of substance abuse or in case of suspected overdose |

4. Additional labs as needed:

| Test | Indication |
|---|---|
| Breath-alyzer | useful for rapid initial assessment of EtOH level and repeat EtOH levels prior to transfer |
| LFTs | on/starting VPA, long hx of EtOH use, hx of hepatitis or in case of suspected OD |
| TSH | depressed or jittery, suggestive signs/symptoms of hypo or hyperthyroid |
| Levels | Valproate, Lithium, Tegretol, Dilantin; Digoxin(ideally at trough = 12 hours after last dose) |
| PT/INR | patient on coumadin |
| U/A | pre-ECT or if elderly and confused |
| EKG | history of cardiac disease; irregular pulse, suspected OD, cocaine intoxication; pre-ECT;male >40 or female >55 and are on/ will start psychotropic or cardiac meds |
| CXR | pre-ECT or if elderly and confused |
| head CT | suspected stroke, bleed, mass |

5. Labs for particular circumstances

| Diagnosis | Labs |
|---|---|
| pre-ECT | CBC, chem7, EKG, CXR, U/A |
| overdose | *Triage to* *medical/ED service!*CBC, chem20 (including LFT’s), EKGFull serum tox screens**Call to request drug levels where applicable.** |
| EtOH | LFT, amylase (if abdominal pain present) |
| new onset psychosis | as needed to r/o delirium (see **Delirium**) |