Our project is a 120 bed hospital addition which includes 28 operating rooms, an expansion of the emergency department, a radiation/oncology department with 8 linear accelerators, and additional support functions. Some of the added spaces include process loads for instrument, cart, and equipment washing and sterilization which we know is to be excluded from the baseline and projected use calculations. The LEED-NC Reference Guide clearly address the usage of water for traditional functions of using water closets, hand washing related to the use of water closets or urinals, and showering. The Guide does not specifically address the usage of water at the multitude of other fixtures that occur throughout a hospital of a possible non-process nature. Due to the inherent nature of using surgical scrub sinks, flushing rim service sinks, housekeeping service sinks, and similar fixtures, the usage of water is more dependent on volume or a combination of volume and time used so identifying a savings, it there is one, is not practical and we would also place these fixtures into the category of process loads. What remains is a large number of sinks that are in exam rooms, patient rooms, and similar clinical spaces that are continuously used by staff for additional hand washing and would account for significant water usage and a corresponding reduction in usage if fitted with faucets that use less water than the base line 2.5 GPM allocated for lavatories and kitchen sinks. The Guide appears to be silent on applying usage factors to these types of fixtures so is it the intent for all of them to be considered process loads, or should we be developing a concept for usage that would permit calculating base line and reduced water usages towards a credit? Since the obvious goal is the real reduction in water usage, it would be appropriate to have a criteria that permits applying additional reductions to achieving a credit.