This brief, 11-item scale covers most of the items examined in Dr. Way et al.’s study (psychosis, depression, suicidality or homocidality, hostility or aggression, uncooperativeness, treatment noncompliance, substance abuse, physical dysfunction, role dysfunction, and social support), and it is interesting that it rates them on a similar 0–6 Likert scale. Reliabilities were originally reported for only the three subscales that emerged from factor analysis in the published article (0.96, 0.92, 0.79), but we reanalyzed the items individually, and they showed interrater reliabilities that, except for homicidality (0.28), ranged from 0.68 to 0.88. Reliability was facilitated by the use of behavioral descriptor anchor points for each pair of 0–6 ratings (mild=1–2, moderate=3–4, severe=5–6). This type of scaling method, originally used by Bigelow and Berthot (3) with the Psychiatric System Assessment Scale (3), has been used for a larger inpatient scale at our facility (4), developed as a modification of the Psychiatric System Assessment Scale, and has facilitated accurate and reliable ratings in our clinical setting. We also demonstrated that this medical necessity scale was valid on the basis of correlations with subsequent inpatient ratings that were carried out independently by different clinicians, including inpatient length of stay, and on the basis of its ability to discriminate between patients requiring and not requiring hospitalization.