The solo emergency: who calls patients when you cannot

What happens to your practice the day you can't work

With no plan, a solo practice simply stops answering. Patients reach voicemail, your calendar keeps booking people who arrive to a locked door, higher-acuity clients lose their only contact, and claims quietly blow past filing deadlines while no one has authority to touch the bank account. The federal small-business continuity framework treats this as a foreseeable risk to plan for, not bad luck 1Ref 1U.S. Department of Homeland Security (2026).Ready.gov Business.The federal small-business continuity framework as the structure a solo practice's coverage plan is built on — identifying functions that cannot pause and who performs each., and HIPAA's Security Rule already requires a contingency plan for your electronic records, scaled to your size 2Ref 2HHS Office for Civil Rights (2026).Summary of the HIPAA Security Rule.That HIPAA's Security Rule already requires a contingency plan for electronic records, scalable to the size of a solo practice..

The fix is not heroics on the worst day of your year; it is a decision made on an ordinary one. A solo who has named a coverage colleague, written a call order, and handed over access turns a catastrophe into an inconvenience. A solo who has not leaves clients, records, and revenue stranded for as long as the illness lasts.

The standing coverage plan — distinct from your professional will

The document that saves you is a standing coverage plan: a short, current playbook for what happens if you vanish from the practice for days or weeks. It overlaps a professional will but answers a different question — you are alive and coming back, so the plan is about temporary coverage and clean handoff, not closure. Build it around the federal continuity structure: identify the functions that cannot pause, name who performs each, and write down exactly how 1Ref 1U.S. Department of Homeland Security (2026).Ready.gov Business.The federal small-business continuity framework as the structure a solo practice's coverage plan is built on — identifying functions that cannot pause and who performs each..

The functions that cannot pause: - Reaching active clients and rescheduling or covering them - Holding higher-acuity and any active-risk clients with real clinical coverage - Answering the phone and the inbox - Releasing records on request - Filing claims and paying rent, payroll, and vendors

Everything else — marketing, non-urgent admin, new-client intake — can wait. Naming the short list is the point: it tells your stand-in what to protect first and gives you permission to let the rest sit.

Who calls patients, and in what order

Name one person whose only job, in the first 24 hours, is to reach your patients — and give them the priority order in advance, because a colleague improvising from your calendar will call alphabetically instead of by risk. The order that works: anyone in active crisis or on a safety plan first, then clients with a session in the next 72 hours, then everyone else. Each call offers a concrete next step, never a diagnosis over the phone.

A written call script keeps the message consistent and lawful: - Identify the caller and their role ("I'm a colleague covering this practice") - State only that the clinician is unavailable for a period, with no clinical detail - Offer the next step: a covering clinician's contact, a rescheduled date, or, for anyone in crisis, a warm connection to 988 or 911 - Document the call, its time, and the outcome

This is the piece worth rehearsing. Everything else can be reconstructed slowly; a client in crisis who cannot reach anyone cannot.

Access and authority: hand over the keys before you need to

Coverage without access is theater. Keep a single current list — in a password manager or a sealed envelope a trusted person can reach — with the EHR admin login, the phone and voicemail system, email, the bank, and the merchant processor. Access alone is not authority: someone has to be legally allowed to act for the practice, which usually means a business power of attorney or a named authorized delegate arranged while you are well.

Separate two kinds of access. Clinical access — reading charts, covering clients — belongs with a licensed colleague. Financial access — moving money, paying bills — belongs with whoever can lawfully touch the account. Sometimes that is one person; often it is two, and the plan should say which is which so no one oversteps their role or freezes because they assume someone else has it.

The covering clinician: what they can and cannot do

A colleague can hold your caseload, but their license and your payers set hard limits on how. They can only treat within their own scope and state license, so a covering clinician licensed elsewhere may need a compact privilege to see your clients by telehealth 3Ref 3Social Work Licensure Compact (2026).Social Work Licensure Compact.That a covering clinician licensed in another state may need a multistate compact privilege to treat clients by telehealth.. And they cannot simply bill under your provider number: Medicare, for one, sets specific rules for who may render and bill behavioral-health services and narrow incident-to constraints, so covering-arrangement billing has to be structured deliberately 4Ref 4Centers for Medicare & Medicaid Services (2025).Medicare and Mental Health Coverage.That Medicare sets specific rules for who may render and bill behavioral-health services, with narrow incident-to constraints, so covering-arrangement billing must be structured deliberately..

This is where a pre-arranged relationship pays off. A common convention is a standing understanding with one or two nearby solos — the locum arrangement, or an even looser mutual-coverage pact — so the covering clinician already knows your practice and the paperwork that makes their coverage lawful is signed in advance rather than scrambled for from a hospital bed.

Records, requests, and privacy while you're out

Your absence does not pause anyone's rights. A patient who asks for a copy of their record is still entitled to it within 30 days, with one 30-day extension, at a reasonable cost-based fee — so someone must be able to receive and fulfill those requests while you are gone 5Ref 5HHS Office for Civil Rights (2026).Individuals' Right under HIPAA to Access their Health Information.That patients retain the right to obtain copies of their records within 30 days (one 30-day extension) at a reasonable cost-based fee, which someone must fulfill during the clinician's absence.. The same record-keeping planning that a professional will addresses covers this: who can access charts, how they release them, and how privacy holds when a stand-in touches the file 6Ref 6American Psychological Association (2007).Record Keeping Guidelines.That record-keeping planning covers who may access charts, how they are released, and how privacy holds when a stand-in touches the file during an absence..

Write down the mechanics, not just the intent. Who monitors the records inbox, what proof of identity a request needs, where copies are produced, and how the covering person logs each disclosure — so that when you return, the trail is clean and no request quietly went unanswered while you were unreachable.

Money doesn't pause: claims, rent, and payroll

The practice keeps owing money whether or not you can sign checks. Timely-filing clocks on unbilled claims run out on schedule, rent and software subscriptions auto-draft, and any staff or contractor still expects to be paid. Decide in advance who has banking authority, set essential bills to autopay where safe, and keep a running note of every payer's filing deadline so a covering biller can protect the revenue you already earned before you went into the hospital.

A short financial appendix to the plan does the work: the bank and processor logins location, the list of recurring obligations with due dates, the payroll or contractor schedule, and a single instruction on which claims to file first. It keeps a temporary absence from turning into a permanent hole in the practice's cash flow.

Build it before you need it: a one-page plan

None of this works if it lives in your head. Put the plan on one page, store it where two different people can reach it, and rehearse the first phone call once a year so it is practiced, not improvised. A common convention among solos is the solo web — a small standing network who agree to cover one another — so no single illness leaves a caseload with nowhere to go.

The one-page plan names: the coverage colleague and an alternate; the patient-call priority order; the access-and-authority holder; the covering clinician and how they may bill; the records contact; and who protects the money. Reviewed on a fixed date each year, the same page becomes your map for reopening after the disaster or the hospital stay, instead of starting from a cold, dark office.