--- - |2+ Background With suicide rising in the United States, identifying and preventing suicides is increasingly important. To provide a valuable step toward achieving effective suicide risk assessment, this study examines the agreement between self‐report measures and psychiatrist documentation of suicidal ideation and behaviors (SI) at a Veterans Administration (VA) psychiatric emergency clinic. Methods A total of 377 veterans presenting at a VA psychiatric emergency clinic completed a self‐report survey on SI and other acute risk factors for suicidal behavior. We examined agreement between veterans’ self‐reported SI and psychiatrists’ clinical notes regarding SI. Results A total of 199 veterans (53%) self‐reported SI; 80 psychiatrist notes (21%) indicated SI. Psychiatrists and veterans differed in 44% (164/377) of cases. Among the discordant cases, the veterans’ self‐report was more severe than the psychiatrists’ in 97% of cases. Of the 120 veterans with SI and documented as having no SI by psychiatrists, 31 (26%) reported having a suicide plan and 18 (15%) plan preparations. Findings were similar when controlling for presenting problem, current depression, presence of a standardized suicide risk assessment, psychiatrist training level, past suicide attempt, homelessness, diagnosis of personality, or substance use disorder. Conclusions Agreement between veterans' self‐reports and psychiatrists’ documentation of SI was generally low, with veterans self‐reporting SI significantly more often than psychiatrists documented SI in their clinical notes. This suggests that inclusion of a self‐report questionnaire provides an additional source of data to complement information gleaned from the clinical interview for a more comprehensive risk assessment, but only if actually examined by the clinician. - Depression and Anxiety, EarlyView.