> ## Documentation Index
> Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# The Patient Letter Object

> A letter exchanged between a practice and a patient, recorded in the patient's chart.

## In the EHR

Patient letters carry written correspondence between a practice and a patient in either direction. A practice user writes to the patient from the patient's chart, and a patient writes to the practice from Patient Passport, Elation's patient portal. Either way the letter is a chart document holding a subject, a body, attached chart items and files, and the signature that releases it. See [Communicating with patients](/articles/Passport--Communicating-with-patients). Correspondence addressed to outside providers, contacts, fax numbers, or Direct addresses is a separate object; see [The Letter Object](/articles/rest/patient-document-api/referrals/the-letter-object).

## Working with patient letters via the API

Three behaviors to know before you build against this object.

**Creating a letter records it in the chart; delivering it to the patient is separate.** A `POST` stores the letter as an unsigned draft, and nothing reaches the patient. A letter cannot be signed on creation, and because delivery requires a signature, it cannot be sent on creation either. Both happen on a later update, which may carry the signature and `send_out` together, so two requests are enough to create and deliver a letter. Make content changes before signing: once a letter is signed, only `send_out`, `patient_read_time`, `viewed_at`, and tags remain writable.

**How a sent letter reaches the patient depends on their portal enrollment.** A patient with a Patient Passport account receives the letter there. For a patient without one, the letter is marked for printing instead, and nothing is transmitted. An integration that handles patient communication through its own channel can still create and sign letters so the correspondence is on file in the chart.

**`is_patient_initiated` records which side wrote the letter, and is fixed at creation.** Send `false` for a letter the practice is writing to the patient, and `true` to record one the patient wrote to the practice. `true` also requires the patient to hold active portal access to that chart at the practice, and `false` requires the patient to belong to the practice. An update that changes the value afterward is rejected, so create a second letter rather than reassigning authorship.

## Field notes

* `category` classifies a patient-authored letter so it reaches the right role at the practice. See [The Patient Letter Category Object](/articles/rest/patient-document-api/patient-letter-categories/the-patient-letter-category-object).
* `tags` holds [Document Tags](/articles/rest/patient-document-api/document-tags/the-document-tag-object).