When a patient is admitted to the hospital, the list of all medications ordered upon admission to the hospital must be compared — or reconciled — with the list of medications the patient was taking before entering the hospital. If any pre-admission medication is not either ordered or explicitly declared to be inappropriate, the nurse or pharmacist should contact the patient’s physician. The physician should then either order the medication or formally confirm that the omission was deliberate. Early in the process of implementing medication reconciliation, someone should talk to all the physicians, asking them to routinely document the reason for excluding any medication on admission — and reminding them of the goal of improving patient safety. A brief note on the order form for each deliberate medication omission will save everyone time and save the physician the effort answering extra questions.