Background: - Glucocorticoids (GC) are among the most commonly prescribed medicationsrnowing to their generic anti-inflammatory and immunosuppressive effects. Adrenal insufficiencyrn(AI) and adrenal crisis are among the major serious adverse effects of long course glucocorticoidrntreatment. Patient education on sick day rules and the use of steroid treatment identifiers arernsome of the strategies that are commonly employed to mitigate the risk of AI and adrenal crisis.rnThis study aimed to assess awareness of sick day rules and use of steroid card at tertiary referralrnhospital in Ethiopia. rn rnMethods: - A cross sectional study was conducted at the outpatient medical clinics at TikurrnAnbessa Specialized Hospital (TASH) over a study period of consecutive six months. A total of 100rnpatients from medical and endocrine clinics who fulfilled the eligibility criteria were recruited torntake part in the study on the day they attended their routine follow-up clinics. Interviewerrnadministered questioner regarding sick day rules and use of steroid identifier was used andrnstatistical analysis was made using SPSS software version 20. The results were presented byrntables, figures and statements and comparison between the groups was made using the Chisquarerntest.rnrn rnResults: The mean age of the participants was 42, ranging from 13 to 81 years. 72% of them werernfemales. Only 27 % of the study participants were aware of the need to make changes on theirrnsteroid dose on the event of acute illness or injury. Endocrine patients showed a betterrnawareness of steroid sick day rules [15/35, 42%] as compared to medical patients [12/65, 18.4%],rnP-value < 0.05. Among the total participants only 2 endocrine patients carried a steroid card.rn rnConclusion and Recommendations: The data highlights that awareness of sick day rules and thernprovision of steroid use identifiers is very low among both endocrine and medical patientsrnreceiving GC treatment. Urgent intervention to address this gap in clinical practice is needed to mitigate serious adverse effects such as AI and Adrenal crisis. Strategies to increase awarenessrnof sick day rules among patients and health care professionals alike including the availability ofrnpatient information leaflets, a universally accessible and locally adaptable steroid use identifiersrnsuch as steroid cards should be implemented at all levels of health institutions where GCrntreatment is initiated.