What information should be included in a note for a patient to have an emotional support dog?

Emotional Support Animal Documentation

An emotional support animal (ESA) letter must document a diagnosed mental health disability and establish that the animal provides necessary therapeutic benefit to mitigate symptoms of that disability.

Essential Components of an ESA Letter

Patient Identification and Provider Credentials

• Include your full name, professional credentials, license number, and contact information 1, 2
• Document the patient's full name and confirm you have an established therapeutic relationship with them 2, 3
• State the date of the evaluation and letter 2

Mental Health Diagnosis Documentation

• Specify the DSM-5 diagnosis (or diagnoses) that qualifies as a disability under the Fair Housing Act or Air Carrier Access Act 1, 2
• Common qualifying conditions include depression, anxiety disorders (social anxiety, generalized anxiety disorder), PTSD, panic disorder, and bipolar disorder 4
• Document that this condition substantially limits one or more major life activities 1, 3

Functional Impairment Assessment

• Describe how the mental health condition specifically impairs the patient's daily functioning 3
• Use standardized assessment tools like the PHQ-9 (particularly item #1 assessing "little interest or pleasure in doing things") to document severity 5, 6
• For anxiety, document the level of anxiety and its impact on the patient's ability to function 6

Therapeutic Necessity Statement

• Explicitly state that the ESA is necessary to afford the patient an equal opportunity to use and enjoy their housing or to travel 1, 2
• Document the specific therapeutic functions the animal provides, such as: reduction of anxiety through tactile stimulation, grounding during dissociative episodes, interrupting undesirable behaviors, providing deep pressure stimulation, or reducing social isolation 4
• Explain how the animal's presence mitigates symptoms of the diagnosed disability 3

Assessment of the Animal-Patient Relationship

• Document that you have assessed the interaction between the patient and the specific animal in question 3
• Confirm that the animal's presence has a demonstrably beneficial effect on the patient's mental health symptoms 3
• Note the animal's temperament and suitability for the ESA role 4

Critical Legal and Clinical Considerations

Scope of Practice Requirements

• Only write ESA letters for patients with whom you have an established therapeutic relationship and have conducted a thorough clinical evaluation 2, 3
• Do not write letters based solely on a brief telehealth consultation or without proper assessment 2
• Ensure you are familiar with federal (Fair Housing Act, Air Carrier Access Act), state, and local laws governing ESAs 2

What NOT to Include

• Avoid providing specific details about the patient's diagnosis beyond what is necessary to establish disability status 2
• Do not use terms like "service animal" or "therapy animal" as these have distinct legal definitions and requirements 1, 7
• Do not suggest the animal requires specialized training, as ESAs are untrained animals (unlike service dogs) 1

Liability and Ethical Pitfalls

• Be aware of liability issues related to ESA aggression or property damage 2
• Recognize that limited research supports ESA effectiveness, though broader research indicates animals may have positive clinical effects on mental illness 1
• Avoid writing letters for patients seeking to circumvent pet policies without legitimate therapeutic need 2, 3

Documentation in Medical Record

• Document in the patient's chart that you conducted a comprehensive evaluation including assessment of mood, anxiety level, thought content, and functional impairment 6
• Record the rationale for recommending an ESA as part of the treatment plan 6
• Note any standardized instruments used (PHQ-9, GAD-7, etc.) and their scores 5, 6