This research addresses two issues concerning the role of primary care physicians in suicide prevention: 1) Are there signals in a patient's medical record that identify patients at increased risk of suicide? 2) Is the pattern of utilization of suicides immediately prior to suicide different from those of other patients? To address these issues, medical records data for suicides and for symptomatically depressed and non-depressed enrollees of an HMO were compared. Suicidal ideation and behavior, selected psychiatric diagnoses, and interpersonal problems were associated with suicide. However, information recorded in the medical record did not reliably discriminate suicides from controls. There were no substantial differences in the use of general medical services between the suicides and the controls. Less than 20% of the suicides visited a primary care physician in the month prior to death. Only 39% of suicides received specialty mental health treatment in the 18 months prior to death.