Every CCS case ends the same way. The software cuts you off, tells you the case is concluding, and hands you one last window — roughly two minutes of real time — to enter whatever orders you want. You will not see any results from them. Most test-takers either freeze, dump a pile of random orders, or click through it entirely.
That window is not a formality. It is graded, and it is the cheapest block of points on Day 2, because you are not reasoning through a differential. You are running a checklist you memorized weeks ago. This is that checklist.
What the Final Screen Actually Is
When the case ends, you get a final opportunity to place orders. No results come back. Nothing you order here changes the patient's course in the simulation, and you will get no feedback that anything landed.
That silence is why people undervalue it. But the scoring algorithm evaluates the actions you took across the case, and orders placed on the final screen count as actions taken. Indicated actions earn credit. That is the whole mechanism.
Two minutes is not much. You do not have time to think. You need a fixed sequence you can type without deliberating, and that is the entire point of building the checklist in advance.
What It Can and Cannot Rescue
Be clear-eyed about this, because it is where the screen gets oversold.
It cannot rescue a missed diagnosis. Timing and sequencing affect your score — correct management made after a delay in simulated time may receive little or no credit. If you failed to give antibiotics for six simulated hours, ordering them on the final screen does not retroactively fix the case. The clock already ran.
It cannot rescue a missed consult that should have been urgent. Same logic. A STAT cardiology consult ordered after the case has ended is not a STAT consult.
What it does capture is the category of orders that are time-insensitive and genuinely belong to the patient's care: counseling, screening, immunizations, follow-up, and discharge planning. These are correct at the end of the case by their nature, so placing them at the end costs you nothing.
The honest framing: the final screen is where you collect the points you were always entitled to, not where you undo a case you mismanaged. For the mismanagement side, the CCS mistakes to avoid is the better read.
The Universal Checklist
Run this in order on every case. Skip anything that does not apply to the patient's age, sex, or risk profile — ordering a mammogram on a 24-year-old man is not free, it is noise.
1. Counseling
• Smoking cessation counseling (if any tobacco history)
• Alcohol counseling or screening
• Substance use counseling where the history supports it
• Diet and exercise counseling
• Safe sex counseling and contraception in the appropriate age group
• Seat belt, helmet, and firearm safety counseling
• Medication adherence counseling
2. Immunizations
• Influenza vaccine, seasonally
• Pneumococcal vaccine by age and risk
• Tdap or Td booster
• Zoster vaccine in the appropriate age group
• Hepatitis B vaccine in at-risk and diabetic patients
• Routine childhood series for pediatric cases
3. Screening
• Age-appropriate cancer screening — mammography, colorectal, cervical, lung in eligible smokers
• Lipid panel
• HbA1c or fasting glucose
• HIV screening
• Hepatitis C screening in the appropriate cohort
• Bone density where indicated
• Depression screening
4. Discharge and Follow-Up
• Discharge medications, written out
• Follow-up appointment with a named interval and a named clinician
• Specialist referral if the case generated one
• Physical or occupational therapy where relevant
• Home health, visiting nurse, or social work consult
• Return precautions and patient education
• Advance directive discussion in the appropriate patient
5. Loose Ends From This Specific Case
• Pending culture follow-up
• Repeat labs to confirm resolution
• Imaging follow-up for an incidental finding
• Contact tracing or partner treatment for a reportable infection
Numbers one through four are the same on every case. Number five is the only part that requires thought, and it is usually one or two orders.
Orders That Cost You Points
The screen is not a free-for-all. Harmful actions lose credit, and that does not switch off because the case is ending. Ordering broadly to fish for points is a losing strategy.
• No invasive procedures. Nothing that carries risk belongs in a window where you will never see the result.
• No contraindicated medications. The patient's allergies and renal function still apply.
• No shotgun imaging. A pan-scan on the final screen is an unindicated action, not a thorough one.
• No screening that does not fit the patient. Match age, sex, and risk. Mismatched screening reads as indiscriminate ordering.
• Do not re-order what you already ordered. It adds nothing and burns your two minutes.
Adjusting by Setting
Clinic cases. This is where the screen pays best. The patient is stable, the visit is preventive by nature, and the full checklist usually applies. Be aggressive here.
ER cases ending in discharge. Focus on return precautions, the follow-up appointment, discharge medications, and one or two high-yield counseling items. Extensive cancer screening from an ER discharge is less convincing.
Inpatient cases ending in admission. The patient is not going home, so discharge planning is lighter. Lean toward ongoing monitoring orders, vaccines appropriate to admission, therapy consults, and social work.
ICU or unstable cases. Keep it tight. Monitoring, family and goals-of-care discussion, and the consults the case demanded. Preventive screening on a critically ill patient is not indicated care.
How to Actually Have It Ready
Two minutes under exam pressure is not enough time to reconstruct a checklist from memory. The test-takers who clear this window reliably have drilled it to the point where it is muscle memory — the same way you drill an opening order set.
Practice it the same way: run full cases end to end rather than stopping when you reach the diagnosis, and force yourself through the final screen every time. Order-entry speed is the limiting factor, so drilling the typing itself on SpeedOrder pays off directly here. Then run timed cases on CCS Cases and treat the final screen as part of the case, not as the credits rolling.
For the deeper version of the preventive checklist, including screening by age and sex, the preventive care and discharge cheat sheet is the companion to this page. And if you want to understand why these orders count at all, how CCS scoring actually works explains what the algorithm rewards.
Related Guides
• The CCS Preventive Care & Discharge Cheat Sheet