Medical Mutual facilitates continuity and coordination of medical and behavioral health care services across transitions and settings of care. Our initiatives and provider guidelines help ensure members are getting the care or services they need and providers are getting the information they need to provide the care patients need.

Behavioral Health

The Behavioral Health consultant is responsible for obtaining a signed consent form from the patient permitting the communication of important clinical information. If the patient consents to communication, the Behavioral Health consultant is responsible for exchanging information regarding the patient’s evaluation and care plan to the referring physician. The communication should be completed within 30 days of the initial evaluation.

  • Communication Components – The communication should contain the following components when applicable:
  • Clinical Evaluation – Pertinent features of the Behavioral Health evaluation
  • Diagnostic Tests – Results of diagnostic studies and procedures that have been completed and recommendations for additional testing when applicable
  • Clinical Impression – Diagnosis and/or differential diagnosis
  • Treatment Plan – Therapy rendered by the Behavioral Health provider and ongoing management recommendations (e.g., psychotropic medications, psychotherapy and referral to community resources)
  • Follow-up – Recommendations concerning who should provide follow-up care and when those services should be performed

Patient Summary Form

This form template is designed to facilitate communication between providers.


Before a consultation takes place, share all necessary clinical information including the following:

  • Reason for the consultation request
  • Relevant clinical data
  • Scope of consultant’s role (e.g., follow-up care or consultation only)
  • Preferred method(s) of communication from the consultant (e.g., fax, phone, mail, email)

Medical Mutual has created a patient summary form to help our network providers communicate necessary information to the consultant.

Reporting Results to the Referring Provider

A written summary of the consultation and findings should be sent to the referring provider within 14 days following the initial visit. Any preliminary report should be followed by a final report.