2013 marks the 40th year since the term fetal alcohol syndrome (FAS) was coined at the University of Washington. In 1993, the University of Washington opened the first interdisciplinary FASD diagnostic clinic; expanded to a statewide network of clinics in 1995 (Washington State FAS Diagnostic & Prevention Network (WA FASDPN)), and introduced a new, rigorous diagnostic system, the fetal alcohol spectrum disorder (FASD) 4-Digit Diagnostic Code in 1997. The WA FASDPN mission is FASD primary and secondary prevention. Evidence of successful primary prevention (fewer alcohol-exposed pregnancies and FAS births) was documented in WA in the 1990s. Secondary prevention (reduction of disability among individuals with prenatal alcohol exposure) starts with accurate diagnoses and access to interventions that meet patients’ needs.