Neuropsychologists working in inpatient settings are often asked to opine on patients’ capacity to make decisions, such as consenting to medical procedures or formulating a discharge plan. Although the essential components of capacity evaluations—understanding, choice, appreciation, and reasoning—are well documented, application of these principles in clinically complex populations necessitates a pragmatic discussion of how to maximize therapeutic contribution within the larger treatment plan. This chapter will expand upon these basic principles to provide practice considerations for rendering capacity determinations with unique populations, formulating prognosis and thresholds of capacity, guiding effective clinical documentation, utilizing surrogate and supported decision-making, and navigating team dynamics. Additionally, we will examine the role of cultural competence and bias in capacity assessment, the intersection of clinical and medicolegal domains, and discuss the use of artificial intelligence in capacity assessments.