CLINICAL · DOCUMENTS

Clinical letters in mental health, from prior authorizations to treatment summaries

Published June 15, 2026 · Updated October 10, 2026

Progress notes get all the attention, but they are not the only writing on a clinician's desk. A payer wants a prior authorization before it keeps covering a medication. A neuropsychologist needs a referral. A patient moving across the state needs a treatment summary for their new psychiatrist. A denial needs an appeal. Every one of those letters draws on things you have already documented, and every one still means rereading the chart and rewriting it for a reader who isn't a clinician.

You write far fewer letters than notes, but each one tends to show up with a deadline and eat an evening. Below are the letters mental health clinicians write most, what each needs to say, and how MH Scribe drafts them from the notes you already have.

The letters mental health clinicians write most

Most clinical correspondence falls into a few categories. The readers differ, but the skeleton is the same: the clinical situation, the history that matters for this reader, and a specific request or conclusion.

Prior authorizations justify medical necessity to an insurer so treatment is covered. Referral letters hand off a patient to a specialist with the context they need. Treatment summaries bring a new provider up to speed on the course of care. Appeals contest a denial with documentation and reasoning. Return-to-work, accommodation, and ESA letters speak to employers, schools, or housing providers about functional needs. All of them draw on the same record: the diagnoses, medications, and progress already in your notes.

Prior authorization letters

This is the letter that most directly affects care. A late or denied authorization can interrupt a medication that is finally working. The reviewer wants a specific story: the diagnosis, what has been tried, how the patient responded, and why this treatment is medically necessary now. A good prior auth letter reads like the Assessment and Plan of a good SOAP note rewritten for a reviewer who may not be a psychiatrist: diagnosis with specifiers, objective measures, treatment history, and what happens if the medication stops.

Example excerpt: "Ms. R. carries a diagnosis of Generalized Anxiety Disorder (F41.1) and Major Depressive Disorder, recurrent, moderate (F33.1). She has trialed sertraline (inadequate response at 150mg) and bupropion (discontinued due to side effects) prior to escalation to her current regimen. On the current medication her GAD-7 has improved from 18 to 7 over twelve weeks, with restored occupational functioning. Discontinuation or non-formulary substitution would pose a substantial risk of symptom recurrence and decompensation. Continued authorization is medically necessary."

Prior auths depend on diagnosis and treatment history, so they are tied to coding. Our guide to CPT codes covers the medical-necessity language payers look for.

Referral and treatment-summary letters

A referral letter exists to make the next clinician's job easier. It should answer one question, what do you need this specialist to do?, and include only the history that supports it: the presenting concern, relevant diagnoses, current medications, and the clinical question. A treatment summary does related work when a patient transfers care or asks for records. It tells the course of treatment, what was tried, how the patient responded, and where things stand.

Referral, in brief: "I am referring Mr. T. for neuropsychological evaluation to clarify the contribution of attentional versus mood-related factors to his cognitive complaints. He is currently stable on his mood regimen; the specific question is whether his persistent concentration difficulties are better accounted for by ADHD. Relevant history and current medications are summarized below."

The skill in both is leaving things out. A referral does not need the whole chart, and sending less PHI than you could is good practice as well as good manners.

ESA, accommodation, and return-to-work letters

Letters to employers, schools, and landlords carry more weight because someone outside healthcare will act on them. An ESA letter, an accommodation request, or a return-to-work clearance should say only what is within your scope and what you can clinically support: that a condition substantially affects a major life activity, and what functional need the request addresses. Leave out specifics that aren't yours to certify.

Accommodation, in brief: "Ms. K. is under my care for a diagnosed anxiety disorder that, at present, intermittently affects her ability to concentrate in high-stimulation environments. A reduced-distraction workspace or the option to use noise-cancelling headphones would reasonably accommodate this functional limitation. I am happy to provide additional information as appropriate."

Be conservative here. When a request goes beyond what you can support, write what you can attest to and decline the rest. Your judgment decides what goes in, not the template.

Generating letters from your notes

Every letter above restates information you have already documented, in a different shape for a different reader. AI is good at that, and it is the right job for it: reorganizing your record, not inventing clinical content. In MH Scribe, Documents AI drafts letters from your finished notes, never the raw transcript. You choose whether it draws on one session or the patient's whole history.

This is where having your notes in one place pays off. Because MH Scribe already holds the intake, the follow-ups, and the medication history on the patient's clinical timeline, a prior auth that cites three failed trials doesn't send you digging through old notes. Built-in templates cover referrals, treatment summaries, prior authorizations, appeals, and return-to-work and ESA letters, and you can describe any other document and generate it from scratch. Drafts come out on your letterhead with your signature, and anything missing, like a claim number, is left as a marked placeholder. You review and sign every document before it goes out. The notes behind these letters are the same ones you build in a psychiatric intake or a follow-up visit.

Review, sign, and stay compliant

However a letter gets drafted, you are responsible for what it says. Treat the draft as a draft: read it, fix it, and make sure it says what you would say before you sign. The AI saves you the typing. The accountability stays with you.

Letters get the same protection as the notes they come from. MH Scribe handles PHI under a HIPAA Business Associate Agreement and never uses your data to train AI models. We explain why the BAA is built into our Terms in a separate post. Documents count toward the free plan's monthly AI generations and are unlimited on Pro; the pricing page has details. To see how letters and documents compare across tools, read our AI scribe comparison.

Turn the notes you already wrote into letters

Documents AI drafts referrals, treatment summaries, prior authorizations, and any letter you describe from your clinical notes, on your letterhead, for you to review and sign.