Contents of the Template
- Patient Details Section: Clearly outlines the necessary personal information of the patient, including full name, date of birth, patient ID/SSN, contact address, and phone number.
- Condition Details Section: Allows for precise listing of the patient’s diagnosed mental health disorder(s), using the DSM-5 or ICD-10 codes and descriptions.
- ESA Recommendation Section: Includes an area where the healthcare professional can detail their recommendation for an Emotional Support Animal as part of the patient’s treatment plan.
- Animal Details Section: Provides space for detailed information about the recommended Emotional Support Animal, including the type, name, breed, age, and weight of the animal.
- Declaration Section: Contains a clear and formal statement by the healthcare professional regarding the patient’s need for an ESA, emphasizing that the letter does not constitute a disability certification but confirms the need for an ESA.
Why Use This Template
- Clarity and Structure: The template is organized in a clear and systematic manner, making it easy for healthcare professionals to provide all the necessary information.
- Convenience: Available in Word and Google Docs formats, it is designed for ease of use, accessibility, and customization according to specific needs.
- Legitimacy and Professionalism: The template is designed to align with the general requirements of various regulations, assisting in the creation of a polished and professional document.
Ideal For
- Healthcare Professionals: Such as psychiatrists, psychologists, general practitioners, and licensed therapists who are treating patients with mental health disorders and have prescribed an Emotional Support Animal as part of the treatment plan.
- Patients Seeking Documentation: Individuals who have been recommended an Emotional Support Animal by their healthcare professional and need a formal document to present to landlords or airline staff.
- Landlords and Property Managers: For reference purposes when they receive an ESA letter from a prospective or current tenant, helping them to understand what a legitimate letter should contain.
- Legal and Human Resources Professionals: Who need to understand the components of a valid ESA letter as part of their role in ensuring compliance with relevant laws and policies regarding Emotional Support Animals.
