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A consultation response, or consultation report, is the written reply a consultant sends to the provider who requested the consultation: findings, diagnostic impression, recommendations, and who does what next. It closes the referral loop the referral letter opened. Psychiatrists, psychologists, and therapists send one after an assessment or a completed course of treatment. Most run 150 to 700 words.
Consultants replying to a referrer: psychiatrists, psychologists, therapists, PMHNPs
The referring provider, the client's chart; payers in Australia and Canada
150 to 700 words · 10 to 20 minutes by hand (clinical team estimate)
Inter-provider correspondence (compare: consultation-liaison note, discharge summary)
After an assessment, and after each completed course of treatment under a referral
A payment condition in Australia and for Canadian physicians; convention for US psychologists
A consultation response and report is the written communication a consultant sends back to the provider who requested a consultation, conveying findings, opinion, and recommendations. It belongs to the family of inter-provider correspondence: the referral letter opens the loop, the consultation report closes it, and a discharge summary closes the whole episode of care. Its modern shape descends from the US Medicare consultation service and its three R's (request, render, report): section 15506 of the old Medicare Carriers Manual made a written report to the requesting physician a mandatory element of billing a consultation, so the document grew up as a billing-integrity artifact as much as clinical correspondence. Clinicians and payers also call it a consultation letter, reply letter, referral response, letter back, GP letter, or closing-the-loop letter.
Its weight now depends on where you practice and what you bill. Medicare stopped paying US consultation codes on January 1, 2010, so for most US clinicians, and for independent-practice psychologists especially, the report back is professional ethics and continuity of care rather than statute; the exception is the interprofessional consult family (99446 to 99451, with behavioral health G codes added for 2025), where a written report is again a payment element. Australia is the strongest mandate: the detailed written report is a fundamental component of the psychiatrist assessment items, and Better Access requires even psychologists to report to the referring GP after each course of treatment. In Ontario the consultant physician must submit findings, opinions, and recommendations in writing to the referring physician, and an incomplete consultation chain pays as a lesser assessment. Keep it distinct from the consultation liaison note, a chart entry inside a shared hospital record rather than outbound correspondence, and never paste psychotherapy notes into it; they stay out of correspondence entirely.
Any clinician who accepts referrals owes the loop a reply: psychiatrists reporting back to GPs after an assessment, psychologists writing to the referring physician after intake or after a course of therapy ends, therapists closing out an EAP or primary-care referral, and specialists answering an interprofessional e-consult. The empirical case for the document is stark: in a large US health system study, only 34.8% of 103,737 referrals produced a documented completed appointment, and referrers and specialists disagree sharply about whether information ever arrives. Send one after the initial assessment, after each completed course of treatment (a Better Access requirement in Australia), and when treatment ends or transfers. A full psychological evaluation report answers a formal assessment referral; an episode that ends produces a discharge summary; the day-to-day coordination in between lives in care coordination notes.
Addressee and referral anchor. Who referred, when, and the question they asked, restated in your first lines. The reply only closes the loop if it visibly answers the request that opened it. Pitfall: a letter that never restates the question; the referrer cannot tell whether their concern was addressed.
Basis and limits. What the opinion rests on: sessions and dates, measures administered, records reviewed, collateral. State what the consultation did not cover. Pitfall: an unbounded opinion; scope you never stated is scope you will be held to.
Findings. Concise and referrer-oriented. Research on what GPs want from psychiatrist reply letters (Selzer and colleagues, 2009) lands on six things: diagnosis, management plan, medication, prognosis, risk, and follow-up timing. Pitfall: pasting the intake note; the referrer needs your synthesis, not your raw record.
Diagnosis and impression. Name it, with confidence level and differentials where honest. Pitfall: hedged formulations with no usable diagnosis; the referrer has to code and act on something.
Numbered recommendations. What you advise, split into what you will do and what you suggest the referrer do, with medication specifics where relevant. Pitfall: advice without an actor; "consider SSRI adjustment" assigned to no one changes nothing.
Responsibility and follow-up. Who owns ongoing management from today: returned to referrer, shared, or retained by you. Name who prescribes, who monitors risk, when you will see the client again, and what should trigger re-referral. Pitfall: the ambiguous handback; unowned follow-up is where referral loops fail.
Sending and copy status. Date sent, method, and whether the client was copied. Australian guidance expects the psychiatrist's report within 2 weeks; Ontario's rules make the written report part of the consultation service itself. Pitfall: a report that was written but cannot be shown to have been sent; auditors have penalized exactly this.
CONSULTATION RESPONSE / REPORT TO REFERRER To (referring provider): _______________________________________________ From (consultant, credentials): ________________________________________ Re (client, DOB): ______________________ Date of report: __________ Referral received: __________ Question asked: _________________________ BASIS OF THIS OPINION (sessions/dates, measures, records, collateral) _______________________________________________________________________ Limits of this consultation: ___________________________________________ FINDINGS (concise, referrer-oriented) _______________________________________________________________________ _______________________________________________________________________ DIAGNOSIS / IMPRESSION _______________________________________________________________________ RECOMMENDATIONS (numbered) 1. ____________________________________________________________________ 2. ____________________________________________________________________ 3. ____________________________________________________________________ RESPONSIBILITY AND FOLLOW-UP Ongoing management: [ ] returned to referrer [ ] shared [ ] consultant Who prescribes/monitors medication: ____________________________________ Follow-up with consultant (if any): ____________________________________ Re-referral triggers: __________________________________________________ SENT Date sent: __________ Method: __________ Client copied: [ ] yes [ ] no Signature/credentials: _________________________________________________
Free to use and share, no signup. The PDF includes a one-page cheat sheet with section-by-section pitfalls and a pre-sign checklist; the DOCX is the blank template, ready to adapt.
Scenario: a psychologist replies to the referring family physician after a two-session assessment of a 41-year-old woman referred for panic symptoms. All details are fictional.
Consultation Report. To: Dr. M. Osei, family medicine · From: K. Brennan, PhD, licensed psychologist · Re: T.V., 41F · Date: 07/24/2026 · Referral received 07/06/2026: "recurrent panic attacks, rule out cardiac anxiety, advise on treatment"
Basis and limits: Two assessment sessions (07/14, 07/21), clinical interview, PHQ-9 and GAD-7, panic symptom log, and your referral summary including last month's normal cardiac workup. No records from prior therapy several years ago were available. This consultation addressed diagnosis and treatment planning; it did not assess fitness for work.
Findings: Ms. V. reports six panic episodes over the past ten weeks with palpitations, dyspnea, and fear of dying, followed by persistent worry about further attacks and avoidance of driving and exercise. GAD-7 13, PHQ-9 7 (item 9 zero). She checks her pulse repeatedly and has attended the emergency department twice despite the normal workup. Sleep onset delayed by anticipatory worry. No agoraphobic housebound pattern; alcohol one to two drinks weekly; caffeine four coffees daily.
Impression: Panic disorder, moderate, with health-focused anxiety features; no current depressive episode. Prognosis good with structured treatment; risk is low, with no suicidal ideation reported at either session.
Recommendations: 1) I will provide CBT for panic disorder, 8 to 12 weekly sessions, including interoceptive exposure and reduction of pulse-checking and reassurance-seeking. 2) Suggest reviewing the prn lorazepam you mentioned: as-needed benzodiazepine use during exposure-based treatment tends to maintain avoidance; a taper conversation at her next visit with you would help. 3) Gradual caffeine reduction. 4) No antidepressant is required for the current presentation in my opinion; if you elect one for her preference or course, treatment here is compatible.
Responsibility and follow-up: I will provide the therapy course and send you a further brief report at completion or by session 12, whichever comes first. Medication decisions and monitoring remain with you. Re-referral triggers: emerging depressive symptoms, suicidal ideation, or no reduction in panic frequency by session 6.
Sent: 07/24/2026 by secure message to your practice; copy offered to and accepted by Ms. V. Signed: K. Brennan, PhD, licensed psychologist.
This sample is fictional and for educational purposes. It does not describe a real patient.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsFor US clinicians the duty is softer than most assume, until a code makes it hard. No statute obliges an independent-practice psychologist to report back to a referrer at all: the APA record-keeping guidelines are aspirational, and the referral loop runs on ethics and continuity of care. The exception is billing an interprofessional consultation (99446 to 99451, or the behavioral health G code family effective 2025), where the written report to the treating provider is part of the service definition. Two privacy boundaries hold in every case: psychotherapy notes as defined in 45 CFR 164.501 are excluded from the report and from electronic health information under the information-blocking rule, and a report to a clinical referrer needs no separate authorization, while reports to attorneys, employers, or insurers follow different consent rules entirely.
In Australia and Canada the report is enforceable. Australia treats the detailed written report as a fundamental component of the psychiatrist assessment items, expects it within 2 weeks, and requires Better Access providers, psychologists included, to send a written report to the referring practitioner after each completed course of treatment. The Professional Services Review has penalized missing reports directly: one 2025 determination cited a practitioner who did not provide a written report back to the referrer, with $325,000 repaid, and another recovered $59,000 where reports could not be located. In Ontario, the Schedule of Benefits requires the consultant physician's findings, opinions, and recommendations in writing, and pays a lesser assessment fee when the consultation chain is incomplete. Retention follows your college or state rules: 10 years in Ontario with 15 advised, effectively 16 years in British Columbia per CMPA guidance, and state by state in Australia with longer periods for records made while the client was a minor. Document the send itself, and keep the deeper clinical record in the chart: the report summarizes the psychiatric diagnostic evaluation or assessment behind it rather than reproducing it.
The loop fails more often than clinicians believe: 69.3% of primary care physicians said they usually send referral information, while only 34.8% of specialists said they usually receive it, and the OIG's 2006 audit of the old US consultation benefit found that about 75% of consultations billed to Medicare in 2001, $1.1 billion in improper payments, failed at least one program requirement, with 9% not documented in any record. Australia's Professional Services Review still penalizes the missing reply directly. The BastionGPT Clinical Advisory Board sees the same errors most often in consultation report reviews:
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Rarely by statute, often by payment rule. In Australia the written report is a condition of the Medicare benefit: a fundamental component of the psychiatrist assessment items, and required from Better Access providers, psychologists included, after each completed course of treatment. In Ontario the fee schedule requires the consultant physician to submit findings, opinions, and recommendations in writing. In the US, Medicare eliminated consultation codes in 2010, and no statute obliges an independent-practice psychologist to report back at all; the duty is ethical until you bill an interprofessional consult code, which builds the written report into the service itself.
Less than most first drafts contain. The report is a synthesis for a busy referrer: presentation in a few lines, impression and diagnosis, recommendations, and the plan. Research on GP preferences lands on six essentials: diagnosis, management plan, medication, prognosis, risk, and follow-up timing. The full history, session content, and test detail stay in your chart, summarized in the report only as far as the referrer needs to act.
No. Psychotherapy notes as defined in 45 CFR 164.501 are separately protected under HIPAA, require a specific authorization to release, and are excluded from electronic health information under the information-blocking rule regardless of which type of mental health professional wrote them. They are never part of a consultation report. The report carries your findings and recommendations, not process notes.
Generally yes, for a competent adult, and the referral itself usually implies consent to the return communication. The consequence is jurisdictional: in Australia the report to the referrer is a condition of the Medicare rebate for the psychiatry items and Better Access courses, so refusal can affect the claim. Talk it through with the client, document the decision, and where a rebate depends on the report, make that consequence clear before treatment starts.
No. That is a third-party evaluation, not a clinical consultation: the report goes to the retaining party under the engagement's terms, confidentiality warnings replace the treatment frame, and material compiled in anticipation of legal proceedings sits outside the ordinary record rules. Do not reuse a clinical reply-letter template for forensic work; the audiences and duties are different.
The content overlaps, the document should not. Send a tailored summary: the referrer wants the answer, not the raw intake, and legacy US consultation guidance always preferred a separately identifiable report. Practically, a one-page letter derived from the intake reads better, travels safer, and answers faster than six pages of assessment detail.
Only where a payer sets one. Australian guidance expects the psychiatrist's report to the GP within 2 weeks, and hospital records in the US must be complete within 30 days of discharge, but no US or Canadian rule sets a general deadline for a psychologist's reply. Convention is prompt: after the assessment, after each completed course, and at treatment end. The longer the gap, the less the referrer can use it.
Say so in the report. In Australia the psychiatrist moves from the single-assessment item to the ongoing-management items, and a report to the referrer is still expected. In the US, a consultation that becomes ongoing care is a transfer of care, and the interprofessional consult codes cannot be used to arrange one. Either way, the loop-closing letter is where you state that responsibility has shifted and what the referrer should still watch.
Give it the assessment note or dictate the outcome, and it drafts the reply letter referrer-first: question restated, findings condensed, diagnosis and recommendations numbered, responsibility and re-referral triggers explicit. It checks the send block, keeps psychotherapy-notes material out, and produces the client's plain-language copy alongside. BastionGPT is HIPAA-compliant with a signed BAA, and your data is never used to train models.
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.