This article describes a hybrid standard setting method that combines characteristics of the Angoff (1971) and Bookmark (Mitzel, Lewis, Patz & Green, 2001) methods. The proposed approach utilizes strengths of each method while addressing weaknesses. An ordered item booklet, with items sorted based on item difficulty, is used in combination with individual item ratings rather than a bookmark placement. The ordered item booklet attempts to make individual item ratings more palatable by providing some amount of information about item difficulty to the Subject Matter Experts (SMEs) participating in the standard setting. Allowing for individual item ratings attempts to addresses the issue of SMEs disagreeing with the order of items in the booklet in a Bookmark standard setting. This article illustrates the method as it was applied to a healthcare examination used for state licensure, comparing it with a more traditional Angoff approach. Results suggest that the proposed method has promise for future use pending further exploration.