Emotional Support Animal (ESA) Letter Evaluation and Documentation
I cannot provide an ESA letter template based on the evidence provided, as all the research materials focus exclusively on erythropoiesis-stimulating agents (ESAs) for anemia management in chronic kidney disease and cancer patients, not Emotional Support Animals.
However, based on the limited relevant research evidence available 1, 2, 3:
Clinical Evaluation Requirements
Before writing any ESA letter, you must conduct a comprehensive psychiatric evaluation documenting a diagnosed mental health disability under the Americans with Disabilities Act and establish that the specific animal directly ameliorates symptoms of that disability 2, 3.
Essential Documentation Components
Establish a legitimate therapeutic relationship with documented treatment history, not a one-time evaluation for the sole purpose of obtaining an ESA letter 2, 3
Document a specific DSM-5 diagnosis that qualifies as a disability substantially limiting one or more major life activities 1, 2
Demonstrate medical necessity by documenting how the specific animal directly ameliorates identified symptoms of the diagnosed condition 2, 3
Assess functional impairment without the animal and document expected improvement with the animal's presence 2
Critical Legal Considerations
Understand you are making a disability determination when writing an ESA letter, which carries legal and liability implications 3
Verify compliance with Fair Housing Act requirements if the letter is for housing accommodations 1
Note that ESA protections do NOT extend to public spaces unlike service animals under the Americans with Disabilities Act 1
Evidence Limitations
The research base supporting ESA effectiveness is extremely limited, making evidence-based practice difficult 3. While general human-animal interaction studies show potential benefits, specific ESA efficacy data is sparse 1, 3.