OBJECTIVES: We sought to understand physician practice patterns for Hepatitis B &C (Hep B & C) screening among patients on Immuno-suppressive medications (ISM). METHODS: Survey study of Rheumatologists and a retrospective chart review of patients receiving ISM’s in rheumatology were undertaken. Data collected included Hep B & C screening practices prior to each ISM. Significant ISM (SISM) use was defined as a) current use of prednisone ≥7.5 mg/day with Hydroxy-chloroquine (HCQ), or (b) ISM use other than only HCQ. Screening rates before ISM were calculated and correlates were derived. RESULTS: Retrospective chart Study: N=200, Mean age: 40 years, 85 % female; 16% were on Biologics and 82% were on SISM. Actual performance measures (PM) for Hep B &C screening ranged between 28-56% prior to ISM initiation. PM’s for Hep B and C prior to ISM were as follows: biologics 72% & 69%; AntiTNF 81% & 71% and SISM 62% & 57%, respectively. Age correlated negatively whereas number of ISM's correlated positively with Hep B & C screening.Survey Study: Survey was mailed to 1200 rheumatologists, response rate: 20% (n=251) Nearly 60% were > 15 years out of fellowship, 46% practicing academics, 43% saw > 80 patients/wk requiring ISM, and 74% spent > 20 hours/week in clinical care. Self-reported PM’s were varied for routine Hep B &C screening and ranged between 28-80% prior to SISM therapy. Age and years out of fellowship correlated inversely whereas gender and number of patients seen per month correlated positively with screening. CONCLUSIONS: Actual screening rates are lower than self-reported rate’s for Hep B & C screening before ISM use. There is a clear need for consolidation and detailing of varied consensus guidelines and improving awareness among rheumatologists regarding the risks of reactivation, need for screening and vaccination in patients needing ISM.