Practice form example

Primary care communication letter

An illustrative template for a psychiatrist's letter back to a primary care clinician after an evaluation. Share only with appropriate consent.

Download the PDFPDF, 1 page, 4 KB. Free, no sign-up. For clinicians.

Educational example only. This is not legal, medical, or compliance advice, and it is not a ready-to-use legal document. Requirements vary by state, payer, and setting. Adapt anything like this to your own situation and have it reviewed by qualified legal and compliance counsel licensed in your jurisdiction before using it in a practice. You are responsible for compliance with all applicable federal and state laws, including HIPAA. shrinkiatry publishes professional commentary and education, not legal or medical advice.

Current as of July 7, 2026. Laws, payer rules, and billing codes change, so confirm the current requirements for your jurisdiction and setting before you rely on it.

What's inside

Header

To: primary care clinician
From: psychiatrist or PMHNP
Re: patient name, date of birth
Date of evaluation

Summary

Reason for referral and a brief formulation
Working diagnosis, stated as clinically appropriate
Current plan: medications, therapy, and monitoring

Coordination

What you're asking of primary care, such as labs, vitals, or shared monitoring, and how to reach you. Note consent and confidentiality, especially for sensitive information.

About this resource

This template is part of the shrinkiatry resource library, a set of free, clinician-facing references and examples. It's reviewed by Shariq Refai, MD, MBA, FAPA, a board-certified psychiatrist, on a quarterly schedule. Next scheduled review: October 1, 2026. First published July 7, 2026, last reviewed July 7, 2026.

Browse the rest of the resource library, or verify who reviews this site. Spotted something out of date? Email corrections@shrinkiatry.com.

Educational and professional commentary only. shrinkiatry explains the profession of psychiatry. It doesn't provide medical advice, isn't a substitute for evaluation or treatment by a licensed clinician, and reading it doesn't create a doctor-patient relationship.