The National Institutes of Health Clinical Center (NIH CC) is the largest research hospital in the United States. Patient safety and clinical quality is a major goal of the hospital. To this end, we implemented a pharmacogenomics program within the NIH CC Electronic Health Record. The program currently consists of genotyping for HLA-A and HLA-B gene variations with clinical decision support (CDS) for abacavir, carbamazepine, and allopurinol and genotyping for drug metabolizing enzymes and transporters (DMET): SLCO1B1 for CDS of simvastatin and TPMT for CDS of mercaptopurine, azathioprine, and thioguanine. This session will review the clinical, laboratory, informatics, and policy decisions involved in implementing pharmacogenomics within an EHR.