The evaluation of medical decision-making capacity is an essential skill used by all physicians in the routine and proper care of patients. Capacity is distinguished from competence, in that a patient’s decision-making capacity is judged clinically by a physician, whereas competence and incompetence are legal judgments made by a judge.1 Failure to be aware of or recall the essential criteria for decision-making capacity can lead to incomplete and perhaps incorrect assessments, or premature consultation (eg, psychiatry, ethics committee).2 A review by Applebaum3 has offered guidelines for the assessment of patient decision-making capacity in the non-emergent setting, but to the best of our knowledge, little has been written to date about the rapid assessment of capacity in emergency situations. Emergencies present a particularly challenging situation for assessing decision-making capacity, as altered mental status is frequently a confounding factor. Stakes may be high, with the absence or delay of treatment quickly leading to loss of life or limb. In an emergency, therefore, it becomes imperative that decision-making capacity be assessed and documented in an efficient manner. This may present a significant challenge for both physicians-in-training and attending physicians. Discord with regard to determination of decision-making capacity may be commonplace among medical staff, despite access to the same clinical information and laboratory data. Although several tools exist that can assist in the evaluation for capacity,4,5 they frequently prove cumbersome, time consuming, and difficult to perform in an acute care setting.