Service Animal Documentation for Patients with Disability
As a healthcare provider, you do not "get" a patient a service animal—service animals are obtained and trained independently by the patient, and your role is limited to providing documentation of disability if requested, not prescribing or certifying the animal itself.
Understanding Your Role as a Provider
Your involvement in service animal matters is fundamentally different from prescribing medical equipment or therapies:
You cannot prescribe, certify, or approve a service animal—under the Americans with Disabilities Act (ADA), service animals are defined as dogs individually trained to perform specific tasks for a person with a disability, and no formal certification or provider approval is required for legal recognition 1, 2
You may provide documentation of disability only—if the patient requests a letter confirming they have a qualifying disability (physical, sensory, psychiatric, or other), you can provide this documentation, but this does not constitute "prescribing" a service animal 1, 3
The patient is responsible for obtaining and training the animal—service dogs must be individually trained to perform specific work or tasks directly related to the person's disability, which is arranged independently by the patient through specialized training organizations 4, 1
Critical Distinction: Service Animals vs. Emotional Support Animals
Service animals and emotional support animals (ESAs) have completely different legal protections and requirements:
Service animals under the ADA have public access rights and require no certification, registration, or provider prescription 1, 2
ESAs require provider documentation but do NOT have the same public access rights as service animals and are only protected under housing and certain travel regulations 3, 2
Common pitfall: Many patients confuse ESAs with service animals—clarify that if they need an animal for emotional support alone (not trained tasks), this is an ESA, not a service animal 3
What You Should Actually Do for This Patient
Focus on addressing the underlying medical conditions that are causing functional impairment, not on service animal documentation:
Immediate Clinical Priorities
Evaluate the peripheral neuropathy urgently—the patient has new-onset bilateral foot numbness (worse on left) that began 2 weeks ago following a fall, which requires systematic assessment of small fiber function (pinprick, temperature) and large fiber function (vibration, ankle reflexes) to characterize the neuropathy 5
Assess fall risk comprehensively—ask the three key screening questions: "Have you fallen in the past year?", "Do you feel unsteady when standing or walking?", and "Are you worried about falling?" 6
Review the pending lumbar spine imaging—the combination of fall history, new neuropathy, and chronic pain requiring high-dose NSAIDs suggests possible structural pathology that needs evaluation before considering mobility aids 5
Address Pain Management Concerns
The current NSAID regimen is concerning—ibuprofen 800 mg twice daily (1600 mg/day) plus Voltaren gel in a patient with fall history and neuropathy warrants reassessment, as NSAIDs should be used with caution in patients at high risk for renal, GI, and cardiac toxicities 6
Consider alternative pain management—refer to pain management or primary care for multimodal approach including physical therapy, as nonpharmacologic interventions should be considered for pain likely to be relieved or function improved with physical or cognitive modalities 6
Functional Assessment and Mobility Support
Perform objective mobility testing—conduct Timed Up and Go test (>12 seconds indicates increased fall risk) or 4-Stage Balance Test (tandem stand <10 seconds indicates increased fall risk) 6
If mobility is impaired, refer to physical therapy first—before considering any assistive device (including service animals), patients with gait disturbance, neuropathy, and fall history need professional evaluation for appropriate mobility aids, orthotics, or assistive devices 6
Assess for loss of protective sensation—perform 10-g monofilament testing with at least one other assessment (pinprick, temperature, vibration) as part of comprehensive foot evaluation, especially given the bilateral foot numbness 6, 5
If the Patient Specifically Requests Service Animal Documentation
Only after addressing acute medical issues, if the patient asks about service animal documentation:
Clarify what type of animal assistance they are seeking—is it for trained tasks related to fall prevention/mobility (service animal) or emotional support (ESA)? 1, 3
If they want a service animal for mobility/fall prevention, explain that they must independently arrange for a dog to be trained in specific tasks (e.g., balance support, fall alert) through specialized organizations 4, 1
You can provide a letter documenting their disability (history of falls, neuropathy, mobility impairment) if requested, but emphasize this is not a prescription and does not create legal service animal status—only the training does 1, 2
Be aware of policy inconsistencies—26 states have policies incongruous with federal ADA requirements, and 34 states have internal contradictions in their service animal policies, which can create confusion for patients 2
Common Pitfalls to Avoid
Do not write a "prescription" or "certification" for a service animal—this has no legal meaning under the ADA and may mislead the patient about their rights and responsibilities 1, 2
Do not recommend a service animal before optimizing medical management—this patient's neuropathy, pain, and fall risk need thorough evaluation and treatment first 5
Do not confuse service animals with durable medical equipment—unlike wheelchairs or walkers that you can prescribe, service animals are independently obtained and trained 4, 3