988 is a phone number, not a discharge diagnosis. If risk showed up in the visit, the note has to show what you assessed, what you told them to do, whether they agreed, and who you still are after they hang up. “Crisis resources provided” is how a serious visit becomes a pamphlet.
SAMHSA put more money into the lifeline again this week. Fine. The chart does not care about the grant. It cares whether this person leaves the video visit with a plan a stranger could reconstruct.
What the handoff note has to contain
The risk you actually asked about. Ideation, plan, intent, means, access. If you used C-SSRS, score it. We keep a C-SSRS guide. If you did a shorter ask, write the questions and the answers in their words. “Denies SI” next to “I gave my sister the bottle” is a broken note.
The instruction, quoted. “I told her to call 988 if the thinking gets louder tonight, and to go to County ED if she feels she cannot keep herself safe. She repeated it back.” That is a handoff. “Advised 988” is a slogan.
Whether they agreed. People-pleasing patients will nod. If the yes is thin, say so, and write the extra step you took (stayed on the line, called a sister, asked them to walk to the lobby).
Who else knows. Collateral, emergency contact, therapist. 988 does not get a copy of your note. If the safety plan depends on a roommate, the roommate has to exist in the chart.
What you still own
A next touch. Same-day check-in, appointment tomorrow, a message you will send at 9am. If you have no next touch, you did not hand off. You hoped.
Your license and the setting. Telehealth from a rectangle means you cannot walk them to an ED. Write where they are, whether they are alone, and what you would do if this went badly. That paragraph belongs in telehealth notes anyway. On a 988 visit it is the whole game.
If you initiated an emergency evaluation, name the team, the time, and whether you stayed on the call. 988 is not that team. Do not mix them up so it looks like you did more than you did, or less.
Standing language versus this visit
I am fine with 988 on every after-visit summary, the way people used to print a hotline. That is hygiene. It does not document this visit. When the visit was about a fight and a new bottle of lamotrigine, do not paste the crisis block as theater. When the visit was about not wanting to wake up, do not skip it because you already printed it once in April.
Questions I get
Can I let 988 do the safety plan? They can help in the moment. Your note still needs your assessment and your follow-up. You are the treating clinician of record.
What if they refuse 988 and refuse the ED? Document the refusal, capacity as you judged it, and the least-worst plan they will accept. If they meet criteria for an involuntary process in your state, write what you started. This is not a blog post that can do that math for you.
Does mentioning 988 create liability? Wobbling around it creates a worse record. Write the instruction you gave. Write what you did next. Hope is not a plan.