Psychotherapy notes
What counts as psychotherapy notes under HIPAA, how they differ from progress notes, and the extra protection they get — for therapists choosing how to keep their notes.
Psychotherapy notes at a glance
Under HIPAA, psychotherapy notes are a mental health professional's notes recording or analyzing the contents of a counseling session, kept separate from the rest of the medical record (45 CFR 164.501). Most uses and disclosures require the patient's specific authorization, and they are excluded from the patient's right of access. Diagnoses, medications, session times, test results, treatment plans and progress summaries are not psychotherapy notes — they belong to the regular record.
| Defined in | 45 CFR 164.501 |
|---|---|
| Key condition | Kept separate from the rest of the record |
| Disclosure | Specific authorization required for most uses and disclosures — 164.508(a)(2) |
| Patient access | Excluded from the right of access — 164.524(a)(1) |
| Not psychotherapy notes | Medications, session times, modalities, test results, diagnosis, treatment plan, progress summaries |
What counts
| Psychotherapy notes | Not psychotherapy notes (regular record) |
|---|---|
| Your notes analyzing what was said in a session | Medication prescription and monitoring |
| Hypotheses, impressions, process notes | Session start and stop times |
| Notes kept separate from the record | Modalities and frequency of treatment |
| Test results | |
| Diagnosis, functional status, treatment plan, symptoms, prognosis, progress |
The extra protection
- Most uses and disclosures need the patient’s specific authorization (164.508(a)(2)) — a general release isn’t enough.
- They are excluded from the right of access (164.524(a)(1)).
- A health plan can’t require an authorization for psychotherapy notes as a condition of enrollment or payment.
The protection only applies if the notes are actually separated from the medical record.
What this means for your EHR
Check whether your practice management system has a dedicated, separately permissioned area for psychotherapy notes. If notes live in the shared record, they are treated like the rest of the record. See HIPAA for therapists.
Scenarios
Related requirements
Frequently asked questions
What is the difference between psychotherapy notes and progress notes?
Progress notes document care — diagnosis, treatment plan, symptoms, progress — and are part of the record. Psychotherapy notes are the therapist's separate notes on session content. Only the latter get the extra HIPAA protection.
Do patients have a right to see their psychotherapy notes?
Not under HIPAA's right of access. A therapist may choose to share them, and state law may give patients more rights.
Can psychotherapy notes be shared with an insurer?
Generally not without the patient's specific authorization, and a health plan can't make that authorization a condition of payment or enrollment.