Documentation

Warm-Handoff Summary

A short, scannable patient summary the receiving provider can read in about a minute.

Do not enter PHI unless allowed by your facility's policies — prefer initials and approximate values.

Situation

The key facts: why now, what you are asking for, and how urgent it is.

Reason for handoffRequested level of careAcuity

Ready by

Patient

InitialsAgePronounsCounty / regionPregnancy status

Substance use

Primary substanceOther substancesUse pattern

Last use

Overdose in last 90 daysED visit (SU-related, last 90 days)Naloxone on hand

Current MAT / addiction-relevant meds

The receiving clinician may need to confirm current medication, last dose, and bridge plan.

Currently on MAT?

Mental health & safety

Current diagnosesSI / self-harm (last 30 days)Psychiatric medicationsCurrent psychiatric prescriber / therapist

Medical

Relevant medical historyOther current medicationsRecent withdrawal historyAllergies

Social & legal

HousingChildren in home / custody concernsLegal involvement

Insurance & logistics

CarrierCoverage notes (no member ID)Prior authorization neededScheduling / logistics notes (no direct contact info)42 CFR Part 2 release signedThis is what lets the receiver legally talk back to you about this patient.

Sending clinician

NameRoleOrganizationPhoneEmail

Anything else

What would you want to know if you were picking up care for this patient?

This is a documentation aid for clinicians preparing a warm handoff — not medical or legal advice, and not a substitute for direct provider-to-provider communication. Drafts autosave to this browser only; nothing is sent anywhere.