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Meadowlark Clinical Consulting

Adult psychiatric decision support for primary care

PMHNP-led, chart-ready eConsults help primary-care teams work through focused adult diagnostic, medication, lab-informed, and psychiatric-medical questions without transferring routine care.

A direct, written solution for clinics managing complex behavioral-health cases in-house.

Schedule A 15-Minute Clinic Fit Call See A Sample eConsult

Focused Written Support, Clear Scope

  • Clinician-to-clinician written consultation
  • Built for focused adult psychiatric questions
  • Medication, monitoring, referral, lab, sleep, hormone, and medical-overlap considerations
  • No direct patient care, prescribing, refills, or crisis coverage

Most complete, accepted eConsults target a 24-48 business-hour written response.

The Clinic Problem

Most clinics are already managing psychiatric complexity without enough psychiatric support.

Meadowlark gives primary-care teams a simple way to add structured psychiatric input for selected adult cases while keeping care inside the clinic relationship.

The Patient Stays With You

Your team keeps the patient relationship and prescribing role instead of sending every complex behavioral-health question into a long referral queue.

The Provider Gets Structure

Instead of informal hallway advice or trial-and-error medication changes, your clinician receives an organized written report with practical options and guardrails.

The Clinic Avoids A Full Hire

Clinics can access focused psychiatric decision support without recruiting, credentialing, scheduling, and managing another full-time psychiatric role.

Potential Consultation Topics

Focused questions that benefit from organized psychiatric review.

Appropriate questions may involve diagnosis, medication sequencing, side effects, monitoring, or when to manage in-house versus refer. Not every case is appropriate for written consultation.

  • Diagnostic clarification
  • Partial response after multiple medication trials
  • Sequencing, switching, augmentation, or deprescribing considerations
  • Psychotropic polypharmacy
  • Adverse effects, interactions, or unclear medication benefit
  • Monitoring considerations
  • Medical, sleep, metabolic, thyroid, hormone, or medication-related contributors
  • Referral and escalation thresholds

What Is Not Included

Boundaries are part of the model.

  • Direct patient visits
  • Direct prescribing or medication refills
  • Patient portal messages or prior authorizations
  • Emergency, crisis, on-call, or same-day psychiatric coverage
  • Replacement of the treating clinician
  • Medical director services unless separately contracted
  • Legal, forensic, disability, custody, or workers' compensation opinions
  • Billing, coding, reimbursement, or outcome guarantees

How It Works

A simple written workflow your team can understand quickly.

1

Clinic Fit Call

A short introductory call clarifies your clinic type, prescriber mix, behavioral-health pressure points, and the kinds of adult cases your team wants support with.

2

Set Up The Workflow

Your clinic receives a clear process for what to send, where to send it, how the written report returns, and who on your team receives the response.

3

Submit A Focused Question

Your clinician submits the clinical question, current treatment, past trials, safety concerns, relevant labs, and medical context using the agreed clinic workflow.

4

Receive A Written eConsult

Most complete, accepted cases target a 24-48 business-hour response. The treating clinician reviews the recommendations, decides what to implement, and continues patient care.

Sample eConsult Preview

From a messy psychiatric question to a clear next-step plan.

This fictional example shows the kind of clinical thinking a written eConsult can organize for a treating provider. It is not medical advice and does not use patient information.

Clinic Snapshot

Focused question from the treating clinician

Fictional adult patient with persistent depression, fatigue, brain fog, irritability before menses, poor motivation, weight gain, and partial response after SSRI treatment. The clinic wants to know whether to switch SSRIs, augment treatment, address labs and hormones first, or refer for direct psychiatric care.

Current symptoms
PHQ-9 18, GAD-7 11, low energy, non-restorative sleep, impaired concentration, reduced exercise tolerance, cold intolerance, heavy menses, and 7-10 days of premenstrual mood worsening with irritability and crying spells.
Current treatment
Sertraline 100 mg daily for 10 weeks, trazodone 50 mg as needed for sleep, hydroxyzine as needed for anxiety, counseling referral pending, and no current hormone or thyroid-directed treatment.
Medication response
Initial anxiety improvement with sertraline, but continued fatigue, low mood, cognitive slowing, reduced motivation, sexual side effects, premenstrual irritability, and limited functional improvement. The patient sometimes skips trazodone because of morning grogginess.
Relevant data
Ferritin 10 ng/mL, hemoglobin low-normal, vitamin D 24 ng/mL, B12 365 pg/mL, TSH reported within reference range, free T4 low-normal, free T3 2.2 pg/mL, and no recent thyroid antibody, iron/TIBC, folate, A1c, or sleep-apnea screening documented.
Safety and differential
No documented mania, psychosis, or active suicidal intent in the submitted note, but formal bipolar screening, substance-use review, sleep-disorder screening, and cycle-based symptom tracking have not been completed.
Clinic concern
Unclear whether this is antidepressant nonresponse, PMDD pattern, sleep disruption, iron deficiency, thyroid physiology, hormone-related mood symptoms, medication side effect, or a case better managed through direct psychiatric care.
Meadowlark eConsult Excerpt

Structured written recommendations

Clinical formulation

This should not be treated as a simple "failed SSRI" until the clinic confirms dose exposure, side effects, safety, sleep, cycle pattern, and reversible physiologic contributors. The patient has partial benefit from sertraline, which argues for a deliberate next step rather than an automatic switch. Ferritin of 10 ng/mL is clinically relevant in a fatigued patient and may contribute to low energy, poor concentration, restless sleep, exercise intolerance, and reduced antidepressant response. Free T3 of 2.2 pg/mL is low/suboptimal in the setting of fatigue, cold intolerance, weight gain, and low mood, even when TSH is reported as within range.

Before switching SSRIs

  • Verify adequate medication exposure: Confirm daily adherence, time at the current sertraline dose, missed doses, dose timing, GI tolerance, emotional blunting, sexual side effects, and whether trazodone or hydroxyzine is worsening morning fatigue and brain fog.
  • Screen for reasons an SSRI could worsen the case: Complete bipolar-spectrum screening, activation review, trauma/substance-use review, eating-disorder screen, suicidality screen, psychosis screen, and sleep-apnea/restless-legs screen before escalating or switching antidepressants.
  • Correct clear physiologic drag first: Ferritin of 10 should prompt evaluation for heavy menses, diet, absorption issues, or occult blood loss, plus iron repletion through the clinic's protocol. In a fatigued patient with poor sleep or restless-leg symptoms, many clinicians would aim for ferritin recovery into a symptom-appropriate range rather than accepting a low-normal hemoglobin alone.
  • Reassess thyroid conversion: Repeat TSH, free T4, free T3, thyroid antibodies, and symptom review. If free T3 remains low/suboptimal and the clinical picture fits, the treating clinician could consider thyroid-directed options within scope, such as T4/T3 combination treatment or desiccated thyroid preparations like NP Thyroid or Armour Thyroid, with informed consent and monitoring for palpitations, anxiety, insomnia, tremor, bone risk, and over-replacement.
  • Define the cycle pattern: Use daily symptom tracking across at least two cycles. If mood symptoms reliably worsen in the luteal phase, treat it as a PMDD-pattern problem rather than assuming generalized antidepressant failure.

Medication options if symptoms remain impairing

  • If sertraline is partly helpful and tolerated: Consider optimizing sertraline before switching, especially if anxiety has improved and there is no activation, bipolar-spectrum concern, or intolerable side effect burden.
  • If PMDD-pattern irritability is prominent: Consider PMDD-focused SSRI strategy, such as adjusting sertraline strategy around the luteal phase or switching to an SSRI with strong PMDD utility, such as fluoxetine or escitalopram, using standard dosing and monitoring practices.
  • If fatigue, low motivation, sexual side effects, or weight concern dominate: Consider bupropion XL as an augmentation or switch option after screening for seizure risk, eating-disorder history, bipolar-spectrum symptoms, severe anxiety activation, and substance-use concerns.
  • If pain, hot flashes, or menopausal-transition symptoms are part of the picture: Duloxetine or venlafaxine may be more useful than another SSRI for selected patients, while monitoring blood pressure, anxiety activation, sleep, and discontinuation risk.
  • If insomnia and low appetite are the main drivers: Mirtazapine can be useful in some patients, but in this fictional case it may be less attractive initially because weight gain, sedation, and fatigue are already concerns.
  • If bipolar screening is positive or activation emerges: Hold further antidepressant escalation and pursue direct psychiatric evaluation or a mood-stabilizing treatment pathway rather than continuing SSRI trials.

Measurement and follow-up plan

  • Track response with objective anchors: Repeat PHQ-9, GAD-7, sleep quality, cycle symptoms, functional goals, side effects, and medication adherence at each follow-up.
  • Recheck medical contributors: Follow ferritin/CBC, vitamin D, B12, and thyroid markers after treatment changes so mood decisions are based on trend data rather than one visit impression.
  • Use a staged plan: Address safety, iron, thyroid physiology, sleep, and cycle pattern first; then decide whether to optimize sertraline, add bupropion XL, switch to fluoxetine or escitalopram, or use an SNRI based on the remaining symptom pattern.

When to refer or transfer psychiatric care

If the treating clinician is not comfortable managing the psychiatric component, direct psychiatric care is reasonable. Meadowlark Mind & Body may be an option for in-person care in Evanston or telehealth where clinically appropriate, subject to availability, licensure, insurance, and clinical fit. Escalate urgently for suicidality, mania, psychosis, severe functional decline, complex polypharmacy, pregnancy-related concerns, eating disorder instability, or diagnostic uncertainty beyond outpatient primary-care management.

Fictional demonstration only. Actual eConsults depend on the submitted clinical information and remain consultative. The treating clinician is responsible for evaluation, diagnosis, informed consent, prescribing, monitoring, follow-up, documentation, and final decisions.

Who It Is For

Built for clinics that need consistent psychiatric input without building a new role around it.

Adult family medicine and internal medicine
Rural primary-care clinics
NP- and PA-heavy teams
Independent outpatient practices
Clinics without embedded psychiatry
Teams that value written, chart-reviewable recommendations

Clear Scope

The right support for the right clinical situation.

Crisis Or Emergency

Use existing emergency, crisis, higher-level-of-care, or same-day clinical protocols. This service is not emergency coverage.

Direct Psychiatric Care

Use direct psychiatric care when the patient needs evaluation, ongoing specialty treatment, or when your clinic prefers not to manage the psychiatric component. Meadowlark may be an option for in-person or telehealth care when clinically appropriate.

Embedded Care

Use embedded or collaborative-care models when your clinic needs integrated staffing, regular team-based care, or program-level coverage.

Focused eConsult

Use Meadowlark when a treating clinician has a focused, non-urgent adult question that can be reviewed through organized written information.

Service Model

Predictable psychiatric decision support without adding another employee.

Meadowlark Clinical Consulting gives clinics a structured written support pathway for selected adult behavioral-health cases that do not require emergency care or direct psychiatric takeover.

What Clinics Receive

A Written Clinical Decision-Support ReportClear recommendations for the treating clinician

Your team submits a focused adult case question. Meadowlark returns a structured written eConsult that helps the treating clinician decide what to do next.

  • Structured case submission template
  • Clinical formulation and practical next-step options
  • 24-48 business-hour target for most complete, accepted cases
  • Medication sequencing, monitoring, safety, and escalation considerations
  • Lab, sleep, thyroid, hormone, metabolic, and medication-overlap considerations when relevant
  • Referral thresholds, including when direct care at Meadowlark or another specialty setting may be more appropriate

How Service Is Scoped

Fit, Volume, And Pricing ReviewMatched to your clinic's actual workflow

A short fit call clarifies whether this service matches your clinic, how often you expect to use it, and what level of monthly support makes sense.

  • Reviewed around number of prescribers and clinic locations
  • Scoped around expected monthly eConsult volume and case complexity
  • Can include leadership-friendly utilization summaries if useful
  • Designed for focused adult clinician-to-clinician questions, not public patient case submission
  • Final scope is confirmed before your clinic begins submitting eConsults

Why pricing is reviewed privately: Clinics vary by number of prescribers, expected case volume, case complexity, submission quality, turnaround needs, and reporting needs. A short fit call keeps the offer precise, professional, and matched to the clinic's actual workflow.

Clinical Leadership

Led by Brandon Jaggi, PMHNP-BC.

Brandon Jaggi, PMHNP-BC, is a Wyoming-based board-certified Psychiatric Mental Health Nurse Practitioner and owner of Meadowlark Mind & Body.

His background includes inpatient and outpatient psychiatric settings, outpatient medication management, complex psychotropic medication decisions, anxiety, depression, ADHD, insomnia, trauma-related symptoms, mood disorders, polypharmacy, and integrative psychiatric care.

Brandon's broader clinical interests include the overlap between psychiatric symptoms and sleep, thyroid, metabolic health, hormones, medications, lifestyle, and lab patterns. That perspective is useful when clinics are trying to understand whether a psychiatric presentation may be affected by medical, medication-related, sleep-related, or hormone-related factors.

Meadowlark Clinical Consulting is PMHNP-led clinician-to-clinician consultation. It is not psychiatrist consultation, direct patient care, prescribing takeover, or emergency coverage.

FAQ

Common questions from clinics.

Is this direct patient care?

No. This is clinician-to-clinician written consultation. Meadowlark does not directly evaluate the patient unless a separate direct-care arrangement is created and clinically appropriate.

Does Meadowlark prescribe medications for our patients?

No. The clinic's treating clinician remains responsible for prescribing, informed consent, monitoring, follow-up, and final clinical decisions.

Is this crisis care or same-day psychiatric coverage?

No. This service is not for emergencies, crisis situations, suicidal intent, homicidal intent, acute psychosis, severe mania, withdrawal, delirium, or same-day psychiatric decision-making. Clinics should use their existing emergency and higher-level-of-care protocols.

Is the consultant a psychiatrist?

No. Meadowlark Clinical Consulting is led by Brandon Jaggi, PMHNP-BC, a board-certified Psychiatric Mental Health Nurse Practitioner. The service should not be represented as psychiatrist consultation.

What types of cases may fit?

Focused, non-urgent adult questions may fit when the treating clinician is seeking written psychiatric input on diagnosis, medication sequencing, adverse effects, monitoring, polypharmacy, relevant medical contributors, or referral thresholds. Meadowlark may decline cases that are incomplete, outside scope, urgent, or not appropriate for written consultation.

What information is usually needed?

Case submissions generally need a focused clinical question, relevant history, current symptoms, diagnoses, current and past medications, medication response, side effects, safety concerns, screening results when available, vitals or labs when relevant, and medical context. Meadowlark provides a clear submission format so the clinic knows what to include.

What happens if information is incomplete?

Meadowlark may request additional information, return the case, or decline the eConsult if the submission is incomplete, unclear, outside scope, or not appropriate for written consultation.

How are cases submitted?

Accepted clinics use the agreed clinic workflow, not the public website form. Meadowlark provides a clear process for what to send, where to send it, and how the written report returns.

How fast are reports returned?

Most complete, accepted eConsults target a 24-48 business-hour written response. Complex cases, incomplete submissions, holidays, or unusually high volume may require clarification or additional time.

What states are eligible?

Meadowlark Clinical Consulting is currently focused on Wyoming and Nebraska clinics. Eligibility for patient-specific consultation depends on licensure, patient location, clinic setup, coverage requirements, and the agreed submission workflow.

Can the written response be placed in the medical record?

The response is designed to be clear and reviewable. The treating clinic is responsible for deciding how to incorporate consultation recommendations into its own medical record and workflow.

Is reimbursement guaranteed?

No. Meadowlark does not guarantee billing, coding, reimbursement, referral reduction, patient outcomes, or cost savings. Clinics are responsible for their own billing and reimbursement decisions.

Can patient information be entered on this website?

No. Do not submit patient information, protected health information, clinical histories, medication lists, dates of birth, medical record numbers, or case details through this website.

Why is pricing not listed publicly?

Clinic needs vary by prescriber count, expected volume, case complexity, response needs, and reporting needs. Pricing is reviewed during a brief clinic fit call so the service matches the actual workflow.

Request Information

Schedule a clinic fit call.

Use this form for clinic and business inquiries only. It is not a patient-care, referral, or case-submission pathway.

Do not include patient information or protected health information in this form.

Do not include patient names, dates of birth, medical record numbers, diagnoses, medication lists, clinical histories, or case details.

Where does this form go?
Submitting this form opens an email draft addressed to bjaggi@meadowlarkmindandbody.com. The website does not store form submissions. Your email app must send the message for Meadowlark to receive it.

Prefer direct contact?
Call 307-300-5885
Email bjaggi@meadowlarkmindandbody.com