Clinical Summary Letter (School/PCP)

Date: [Full date]

To: [Recipient name, credentials/title, organization/school, address or fax]

From: [Clinician name, credentials, clinic name, phone/fax]

Re: Clinical Summary for [Patient Full Name], DOB [DOB]

[Opening paragraph stating purpose of letter, clinician role and relationship to patient, and timeframe of care] (Tailor to recipient context—for school letters, note that patient/parent authorized disclosure; for PCP letters, state this is shared for care coordination. Conclude by noting this letter summarizes clinically relevant information and does not include psychotherapy notes or detailed session content.)

Clinical Summary

[Diagnosis or clinical impression] (Use "Impression" if provisional. Anchor current symptom status to a specific date using "As of [date]" phrasing. Describe symptom pattern and severity in observable terms. Distinguish patient-reported information from clinician observations using "Patient reports..." vs. "I observed...")

[Functional impact relevant to recipient] (For schools: attention, processing speed, emotional regulation, academic stamina, attendance, social functioning. For PCPs: domains affecting medical management, medication adherence/tolerability, comorbid interactions.) [Treatment provided including modality, frequency, and relevant medications] [Response to treatment contrasting baseline to current status] (If safety considerations are relevant to recipient's planning, include a brief date-anchored statement here. Avoid therapy dialogue, detailed trauma history, or psychotherapy process content.)

Recommendations

• [Recommendation with functional rationale] (For schools: specific accommodation linked to functional limitation. For PCPs: coordination request such as medication continuation, monitoring, or referral.)
• [Additional recommendation] (Include only if applicable.)
• [Recommended duration and review date]

(Omit Recommendations section entirely if the letter is informational only with no specific requests. Phrase as recommendations, not directives.)

Please feel free to contact me at [preferred contact method] if further discussion would be helpful. Any additional information sharing will be provided with appropriate authorization.

Sincerely,
[Clinician name, credentials]
[Clinic name]
[Phone] | [Fax] | [Secure email or portal if applicable]

(Keep total length to one page when possible. Do not include attachments unless specifically needed and authorized.)