Background: An estimated 5 million (20.1%) U.S. adolescents experience at least one major depressive episode annually. In a small pediatric clinic, adolescent depression screenings (ages 12-18) were conducted solely at the clinician's discretion, despite the United States Preventive Services Task Force (USPSTF) recommendations for annual screening. A retrospective chart review (January–December 2023) revealed only 3% (n=11) of eligible patients were screened. Purpose: This quality improvement (QI) project aimed to implement annual PHQ-A screenings and a standardized referral process in an urban pediatric primary care office. Methods: The PHQ-A was integrated into the electronic health record (EHR) and patient portal, and a referral protocol was established. All staff completed training on the initiative through a PowerPoint presentation. Adolescents (12-18 years) without cognitive delays were screened in the clinic or via the patient portal. Patients scoring ≥15 or endorsing suicidality were referred for mental health services or emergency evaluation. Referrals were also provided to patients per their request. Best practice alerts (BPAs) and signage were implemented in the clinic to support staff adherence to the initiative. Weekly audits tracked screening adherence, documentation, and referrals. Results: Over 15 weeks, 91% (n=109) of eligible adolescents completed screening, 6% (n=6) were referred for positive screens, and 16% (n=17) were referred per patient request. Conclusions: Standardizing universal PHQ-A screenings improved mental health conversations, early detection of depression, and intervention in adolescent primary care