Emotional Support Animal Letters (ESA)
Providers who contract with Rula can write letters for Emotional Support Animals for their patients. When prospective patients ask for this, we let them know that providers will need to work with them for 2-3 sessions before they can write this letter, which will be at the provider's discretion.
If you are a provider in California, please see these ESA letter guidelines that went into effect in January 2022.
We recommend these articles for providers who have questions about writing a letter for an ESA for their patients:
Leave of Absence, Disability, or Other Legal Documents
Patients may sometimes need supporting documentation from their mental health provider when requesting accommodations. Please decide if providing a letter, disability or other accommodations falls within your scope of practice or if the patient should contact a primary care doctor. This site offers some state-specific guidance.
Providing disability is up to the provider's clinical judgment and state regulations. We recommend providers think carefully before agreeing to complete legal paperwork for their patients. If you decide to write a letter, give FMLA, or state disability it is best to use your own letterhead and disclose only the minimum necessary information. Send the letter directly to the patient rather than to a non-covered entity (such as a school or employer).
- A Release of Information is not required when providing letters directly to a patient. A Release of Information is necessary when sending a letter to a non-covered entity.
- Use the Release of Information Request Form available in the weblinks of the EHR to request a Rula Release of Information be sent to a patient. Medical Records has up to 30 days in all non-CA states in accordance with HIPAA.
Rula's Letterhead Template
A copy of Rula's letterhead template is available here. The Google doc is in "viewer" mode only– You'll need to make a copy of the document or download it to use it.
Billing for Letters
The time spent on care coordination or case management activities, such as writing letters for patients, is not a billable service through commercial insurance. If you would like to provide these services, you can either conduct that service free of charge or negotiate a separate "fee schedule" in writing with the patient, where they could self-pay you directly for those services (it would not be billed through Rula, you would collect payment independently). Rula does not offer sample fee schedules or letter templates, as this is specific to your private practice and license. If you do this, it is also advisable to provide the letter directly to the patient versus a third party.
Updated