A conceptual design of an organizational decision support system (ODSS) is proposed for the limited domain of hospital-based clinical decisionmaking (H-CDM). The design is a first step in the research program to evaluate the viability of an ODSS for H-CDM. The design is also used as a basis for evaluating two other issues. First, the adequacy of broader conceptualizations of ODSS ,proposed in previous years is evaluated. Our analysis suggests that collectively earlier conceptualizations address all the major issues pertinent to an ODSS f o r H-CDM. Second, the design is examined to identify issues that could be generalized to other decisionmaking domains. Our analysis :rhows that (a) ODSS should include facilities to incorporiate decisionmaking authorities of the agents, and (b) legal and ethical considerations on the dissemination and use of data should be carefully considered in the design of an ODSS.