AI Scribes and AI Note Consent for Therapists: State Laws in 2026
Yes, get your client's written consent before an AI scribe records or transcribes a therapy session, in every state. Illinois, Colorado, and Maine now require written consent by law, Rhode Island's new law points the same way, and Louisiana and Texas require you to tell clients up front. Everywhere else, your profession's ethics code and your state's recording law already expect permission before you record.
AI note tools can save hours each week, but they put your clients' most private conversations into someone else's software. Here's which laws apply, what HIPAA requires, and what a good consent form says.
Business education, not legal, clinical, or compliance advice. AI laws are changing fast; confirm your state's current rules with your licensing board or an attorney before you rely on them. State rules below were checked November 1, 2026.
The short version
- Get written consent first. Make it a separate form, or at least a separately signed section, not a line buried in your general paperwork. Several new laws say a general terms-of-use agreement doesn't count.
- Several states now have scribe-specific rules. Illinois, Colorado, Maine, and Rhode Island require written notice and consent in some form; Louisiana requires you to tell patients out loud before recording. Texas and Nevada add disclosure and review rules.
- Sign a BAA before any client data touches the tool. Under HIPAA, an AI vendor that receives session audio or transcripts is a business associate.
- You review and sign every note. Every new law keeps the therapist fully responsible for what the AI writes.
- Offer a real no-AI option. Colorado and Maine say outright that you can't refuse therapy to someone who declines.
In this guide
- Do therapists need consent to use an AI scribe?
- State AI scribe laws for therapists in 2026
- What HIPAA requires for AI note tools
- What your ethics code says
- What an AI notes consent form should include
- When a client says no (and other tricky cases)
- Frequently asked questions
Do therapists need consent to use an AI scribe?
An AI scribe (or ambient scribe) listens to a session, or reads a transcript or your summary, and drafts a progress note. Most send the audio or text to a vendor's servers, which is why three sets of rules apply at once:
- Recording and wiretap laws. If the tool records or transcribes, you're recording a private conversation. In all-party-consent states such as California and Florida, everyone in the conversation has to agree.
- AI-specific laws. A growing group of states now regulates AI in therapy or in health care visits directly (see the table below).
- HIPAA and your ethics code. These apply in every state, whether or not your state has passed anything new.
So even in a state with no AI law, the safe answer is the same: explain the tool, get written agreement before the first session that uses it, and make it easy to say no.
The risk isn't hypothetical. In late 2025, a patient filed a proposed class action against Sharp HealthCare in San Diego, alleging an ambient AI tool recorded his doctor's visit without consent under California's all-party recording law. The claims are unproven, but it shows how a skipped consent step becomes a lawsuit.
State AI scribe laws for therapists in 2026
These are the state laws we found that affect AI note tools for therapists, read against the enacted text or the legislature's own summary. Checked November 1, 2026.
| State | Law | What it means for AI notes | In effect |
|---|---|---|---|
| Illinois | Wellness and Oversight for Psychological Resources Act, 225 ILCS 155 (Public Act 104-0054) | If a session is recorded or transcribed for AI notes, tell the client in writing that AI will be used and why, and get written, revocable consent. General terms of use don't count. Fines up to $10,000 per violation. | Since August 2025 |
| Colorado | HB 26-1195 | Before AI records or transcribes a session, give advance written notice of the AI and its purpose, and get written consent. Declining can't be a reason to deny therapy. Consent is needed once unless the use materially changes. | August 12, 2026 |
| Maine | LD 2082 (Public Law 2025, ch. 687) | Like Illinois, plus the notice must explain how session data is stored, kept, used for training, and deleted when therapy ends. Initialing a specific section of your consent form counts. You can't deny therapy to someone who declines. | Signed April 13, 2026 |
| Rhode Island | H 7349 Sub A / S 2197 and the AI Notification Act, S 2570 | The therapy law requires written notice and consent when AI assists in a recorded or transcribed session, though its wording is narrower (see below). The notification act requires licensed providers to tell patients when AI documents a visit and to review it for accuracy. | June 2026 (on passage) |
| Louisiana | Act 649 (HB 475), R.S. 37:22.1 | Tell the patient out loud, before recording, that you use an AI transcription tool. Disclosure only; the final law dropped the consent requirement. Your licensing board can discipline violations. | August 1, 2026 |
| Texas | HB 149, Bus. & Com. Code 552.051(f) and SB 1188, Health & Safety Code 183.005 | If AI is used in relation to a health care service, give a clear, plain-language disclosure by the first date of service. SB 1188 adds review and disclosure duties when AI is used for diagnostic purposes. | HB 149: January 1, 2026. SB 1188: September 1, 2025 |
| Nevada | AB 406 (2025) | Bars AI from providing care directly, but lets therapists use AI for administrative support, including "organizing, tracking and managing files or notes" for a session. You must independently review the AI's output and follow HIPAA. No specific consent form required. | July 1, 2025 |
| California | SB 903 (vetoed) | Would have required written consent for AI recording or transcription of therapy. Vetoed in fall 2026. The all-party recording law still applies, so get consent anyway. | Not in effect |
A few honest notes on this table:
- Rhode Island's wording is unclear. As written, the consent rule in the therapy law refers to AI "designed to simulate emotional attachment, bonding, or dependency or artificial intelligence companions." Whether that reaches an ordinary note tool isn't settled. Some summaries also say the notification act gives patients a right to opt out; we didn't find that in the bill text we read. Get written consent either way.
- Texas's laws may not fit note tools neatly. SB 1188 covers AI used "for diagnostic purposes," which a scribe may not be; HB 149's "in relation to health care service or treatment" arguably includes one. Disclose anyway.
- Maine's exact effective date follows its usual 90-days-after-adjournment rule; we didn't confirm the date.
- Your state isn't listed? As of November 1, 2026 we didn't confirm a scribe-specific law there, but our search of every state wasn't exhaustive and bills are moving quickly. Recording law, HIPAA, and your ethics code still apply. Your state's rules page links to your licensing board.
What HIPAA requires for AI note tools
HIPAA doesn't require a separate client consent for documenting treatment. It does require something else that matters just as much: a business associate agreement (BAA).
HHS says a vendor that creates, receives, maintains, or transmits protected health information for you is a business associate, and you need a signed BAA before you share any. Its cloud computing guidance adds that this is true even if the vendor only stores encrypted data it can't read. Session audio, transcripts, and your own summary all count as protected health information.
Before you turn on any AI note tool, get answers to these questions in writing:
| Question to ask the vendor | Why it matters |
|---|---|
| Will you sign a BAA, and does it cover the AI feature? | Some EHRs add AI through a third-party vendor that may need its own agreement. |
| Is audio stored? If so, when is it deleted? | Many tools delete audio right after the note is drafted. Some keep it. |
| How long are transcripts kept? | Your consent form has to say this in Maine, and clients will ask everywhere. |
| Is client data used to train AI models, even de-identified? | Some tools keep de-identified transcripts by default unless you opt out in settings. |
| Where is the data processed, and by which AI company? | You should be able to tell a client who handles their words. |
Never paste client information into a consumer chat app such as personal versions of ChatGPT or Claude; those plans don't come with a BAA. Use them only for business tasks with no client details, like drafting website copy.
What your ethics code says
No major ethics code bans AI notes. All of them already require permission before you record a client, and they expect you to explain the tools you use.
- Psychologists: APA Ethics Code Standard 4.03 requires permission from everyone before recording their voices or images, and Standard 3.10 covers informed consent. The APA's ethical guidance on AI in practice (June 2025, updated December 2025) says psychologists should explain an AI tool's purpose, benefits, and risks, make sure it can be used in compliance with HIPAA, and "remain responsible for final decisions."
- Counselors: the ACA Code of Ethics requires permission before recording sessions (B.6.c) and informed consent about technology you use (Section H).
- Social workers: the NASW Code of Ethics requires informed consent before audio or video recording (1.03(i)).
- Marriage and family therapists: the AAMFT Code of Ethics requires written informed consent before recording (1.12).
The codes and new laws agree: tell clients, get their agreement, protect the data, and review every note. An AI draft can include things that didn't happen or miss what mattered. The signed note is still yours.
What an AI notes consent form should include
A good AI notes consent meets the strictest laws on this list, so it works in every state. It belongs with the rest of your intake paperwork, which the free checklist lays out in order for your state. Checklist:
- Name the tool and say plainly what it does (drafts notes from a recording, a transcript, or your summary).
- Say whether sessions are recorded or transcribed, and that nothing starts until the client agrees.
- Say what happens to the data: how long audio and transcripts are kept, when they're deleted, and whether any of it is used to train AI. Use what your vendor actually publishes, not a guess.
- Say who processes it: the vendor, under a business associate agreement.
- Say what AI doesn't do: it doesn't talk to the client, diagnose, or make treatment decisions, and you review and sign every note.
- Make it voluntary: the client can say no or change their mind at any time, and their care won't change.
- Get a separate signature or initials, in writing or electronically, and keep it in the chart.
- Cover everyone in the room: in couples, family, or group sessions, each person needs to agree.
Here's sample language you can adapt. Change the bracketed parts, and have your attorney review it for your state:
Consent to AI-assisted notes
I use [tool name], an AI tool, to help me write my session notes. With your permission, it [records / transcribes] our sessions so it can draft a note for me. The audio is [deleted right after the note is drafted], and the transcript is [deleted within X days / when I sign the note]. [Tool name] has signed a business associate agreement with me and [does not use your information to train AI]. The AI doesn't talk with you, diagnose, or make decisions about your care. I read, correct, and sign every note myself.
Saying yes is optional. If you say no, or change your mind later, I'll write notes on my own and your care won't change. Just tell me, in session or in writing.
☐ I agree to AI-assisted notes. ☐ I do not agree.
Client signature, date
How Well Launched helps: The program's Set up AI notes, with guardrails step compares AI note tools side by side, including what each one publishes about audio, transcripts, and AI training, and checks that you have a BAA in place. Your starter paperwork then builds an AI-assisted notes consent around the tool you chose and your state's rules, with a no-AI option built in. Most steps take about ten minutes, which was the size of the windows I had when I opened my own practice on maternity leave. You can see what each plan includes on the programs page.
When a client says no (and other tricky cases)
A client declines. Write notes without the tool, and note it in the chart so the tool stays off. In Colorado and Maine, refusing AI can't be the reason you deny therapy; it's a good rule everywhere.
A client agrees, then changes their mind. Every new consent law makes consent revocable. Turn the tool off for that client, note the date, and ask your vendor how to delete stored transcripts if the client wants that.
Couples, families, and groups. Get consent from everyone present. One partner's signature doesn't cover the other.
Minors. The new laws let a legally authorized representative consent. Check your state's rules for minors who can consent to treatment on their own.
Telehealth across state lines. Follow the rules where your client is located, and the stricter recording rule if you're in different states.
Frequently asked questions
Do I need written consent to use an AI scribe in therapy?
Yes, in practice. Illinois, Colorado, and Maine require written consent by law when a session is recorded or transcribed, and every major ethics code requires permission before recording. Written consent is the safest standard in every state.
Is an AI scribe HIPAA compliant?
Only if you use it in a HIPAA-compliant way. The vendor must sign a business associate agreement before any session data is shared, and you still need to check how long it keeps audio and transcripts and whether it trains AI on them.
Can I use ChatGPT to write therapy notes?
No, not the consumer version. Personal and free AI chat plans don't come with a BAA, so pasting session details into them shares protected health information without the safeguards HIPAA requires. Use a clinical note tool that signs a BAA, or write notes yourself.
Do I need new consent every session?
No, usually not. Colorado's law says consent is needed once, unless the purpose or manner of AI use materially changes. Ask again if you switch tools or start recording when you didn't before.
Can I put AI consent inside my informed consent form?
Yes, if it's separately signed. Maine's law allows initialing a specific section of your consent-to-treatment form, while Illinois and Rhode Island say a general terms-of-use agreement doesn't count. A separate signature line keeps you safe everywhere.
Sources
- Illinois Public Act 104-0054, Wellness and Oversight for Psychological Resources Act (225 ILCS 155)
- Colorado HB 26-1195, Psychotherapy Artificial Intelligence Restrictions
- Maine LD 2082, Public Law 2025, chapter 687
- Rhode Island H 7349 Sub A, Oversight of Artificial Intelligence Technology in Mental Health Care Act
- Rhode Island S 2570 Sub A, Use of Artificial Intelligence by Healthcare Providers Notification Act
- Louisiana Act 649 (HB 475) of 2026, résumé digest
- Texas HB 149 (2025), enrolled text
- Texas SB 1188 (2025), enrolled text
- Nevada AB 406 (2025), enrolled text
- California SB 903 (2026), bill history
- California Health Care Foundation, "Newsom approves 3 health care AI bills, vetoes 2" (October 8, 2026)
- California Penal Code 632
- Florida Statutes 934.03
- Becker's Hospital Review, "Patient sues Sharp HealthCare over ambient AI use"
- HHS, Business Associates guidance
- HHS, Guidance on HIPAA and Cloud Computing
- American Psychological Association, Ethical Principles of Psychologists and Code of Conduct
- American Psychological Association, Ethical guidance for AI in the professional practice of health service psychology
- American Counseling Association, 2014 ACA Code of Ethics
- National Association of Social Workers, Code of Ethics
- AAMFT Code of Ethics
Setting up your paperwork?
The free checklist walks you through opening your practice in order for your state and license, including your intake paperwork. When you want the forms and the AI notes setup done with you, see the plans.
Related: How to start a private practice as a therapist · What is a practice management system? · The client intake process for therapists
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