---
title: Telehealth follow-up brief Note Template & Example | Nextvisit
description: 15-20 minute telehealth check-in with POS, modifier 95, and patient/provider location. Sized for 99213/99214.
url: "https://nextvisit.ai/templates/telehealth-followup-brief"
type: static
generatedAt: "2026-09-21T03:14:00.690Z"
---

Note template
# Telehealth follow-up brief Note Template & Example

15-20 minute telehealth check-in with POS, modifier 95, and patient/provider location. Sized for 99213/99214.

Updated May 7, 2026

A stable 15-minute video check-in is not a 60-minute intake. A full SOAP on a brief visit inflates the note and can mismatch the billed level of service.

The format supports low-acuity telehealth in psychiatry, therapy, and primary care behavioral health. It supports video and audio-only visits where state law allows. The format holds POS, modifier, and location fields that telehealth audits review. Common codes include 99213 and 99214 with modifier 95, and 90832 for brief therapy.

```
Patient: [patient_name]    DOB: [dob]    Age: [age]
Date: [encounter_date]     Provider: [provider_name]    Duration: [duration]
Visit type: video / audio-only (with state-law justification)
Place of service code: [pos_code]    Modifier: [modifier]
Patient location at time of visit: [city, state]
Provider location at time of visit: [city, state]
Patient consent for telehealth confirmed this visit: yes / no
Identity verified: yes / no    Verification method:

Subjective
- Reason for follow-up:
- Interval since last visit (key changes):
- Medication adherence and side effects:
- Symptom check (mood, sleep, anxiety, panic, energy, appetite, focus):
- Substance use update:
- Psychosocial stressors:
- Patient questions or concerns:

Objective
- Mood and affect (as observed on video):
- Speech:
- Engagement and orientation:
- Visible distress, agitation, intoxication, or safety concerns on screen:
- No physical exam (telehealth) / vitals patient-reported:

Risk assessment
- Suicidal ideation:
- Homicidal ideation:
- Acute safety concerns:
- Local emergency contact and address verified for the visit: yes / no

Assessment
- Diagnosis (continued):
- Clinical impression (stable / improving / worsening):

Plan
- Medication continued:
- Medication changes (drug, dose, reason, monitoring):
- Prescription sent (e-prescribed to: [pharmacy_name]):
- Refills authorized:
- Therapy or referral coordination:
- Labs ordered (with local lab if needed):
- Patient education provided:
- Next visit (telehealth or in-person):
- Follow-up interval:
- Clinician available for urgent contact between visits via:
```

AriaMD keeps the note brief. Patient location, provider location, and telehealth consent have their own fields. Mood and affect are captured as observed on video, with a note that no physical exam was performed. E-prescribing details flow into the plan. The visit still files on the longitudinal chart.

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