Therapists and AI: what HIPAA and state law say about session notes in ChatGPT
An AI tool could turn your session notes into a tidy progress note in seconds. Before you paste, three sets of rules may apply: HIPAA, your state's therapy law, and your state's AI rules. Here is what each one says, from the government's own pages.
This is for psychologists, counselors, social workers, marriage and family therapists, and their practice staff. It is based on HHS guidance and on state laws, listed at the bottom. Every quote was checked on the issuer's own site on October 24, 2026.
Does HIPAA apply to you?
HIPAA covers "covered entities." HHS lists psychologists among the health care providers that can be one, but only if they send health information electronically in a standard transaction, such as an insurance claim. If you bill insurance electronically, assume HIPAA applies. If you are private pay only, check with HHS's own decision tool or your counsel. Your state's confidentiality law applies either way.
HIPAA: the AI company may be a business associate
HHS guidance on cloud services says:
"When a covered entity engages the services of a CSP to create, receive, maintain, or transmit ePHI (such as to process and/or store ePHI), on its behalf, the CSP is a business associate under HIPAA."
A CSP is a cloud service provider. The same guidance says you and that provider must sign a business associate agreement, called a BAA. It also says a provider is still a business associate even if it only holds encrypted data and has no key.
What this means for AI: if you put a client's health information into an AI service, the question is whether you have a BAA with that company. OpenAI's enterprise privacy page says it can sign a BAA for its API Platform, and it describes a separate product called ChatGPT for Healthcare. We found nothing on that page offering a BAA for the Free, Plus or Pro plans. See what OpenAI says about each plan.
HIPAA: what "de-identified" really means
Data that is properly de-identified is outside the HIPAA Privacy Rule. HHS says:
"De-identified health information created following these methods is no longer protected by the Privacy Rule because it does not fall within the definition of PHI."
But "these methods" are specific. There are two: Expert Determination, where a qualified expert studies the data and documents that the risk of identifying someone is very small, and Safe Harbor. Taking out a name is not either one.
Safe Harbor: 18 kinds of identifiers
Under Safe Harbor, you remove all 18 kinds of identifiers below. That covers the client, and also their relatives, employers and household members. In our words:
- Names
- Places smaller than a state: street address, city, county, ZIP code (the first three ZIP digits may stay in some cases)
- Every part of a date except the year, for dates tied to the person (birth, admission, discharge, death), and all ages over 89
- Phone numbers
- Fax numbers
- Email addresses
- Social Security numbers
- Medical record numbers
- Health plan beneficiary numbers
- Account numbers
- License numbers and similar ID numbers
- Vehicle identifiers and serial numbers, including license plates
- Device identifiers and serial numbers
- Web addresses (URLs)
- IP addresses
- Biometric identifiers, such as finger and voice prints
- Full-face photos and similar images
- Any other unique identifying number, characteristic or code
There is one more condition. Even with all 18 gone, HHS says the covered entity must not have "actual knowledge" that what is left could identify the person. Session notes are full of that kind of detail: a rare job, a named school, a family event that made the local news.
Illinois: a law about AI in therapy
Illinois passed the Wellness and Oversight for Psychological Resources Act, Public Act 104-0054. It took effect August 1, 2025. It covers licensed professionals who provide therapy in Illinois, including clinical psychologists, social workers, professional counselors, and marriage and family therapists.
- AI may help with paperwork. The law allows AI for "administrative support" and "supplementary support." Supplementary support includes "preparing and maintaining client records, including therapy notes."
- You stay responsible. The licensed professional must keep full responsibility for everything the AI does, produces and uses.
- Recorded or transcribed sessions need consent. If the session is recorded or transcribed and you use AI for supplementary support, you must first tell the client in writing that AI will be used and what for, and get their consent.
- Consent must be real. The law says accepting broad terms of use does not count as consent.
- Some uses are banned. AI may not make independent therapeutic decisions, talk with clients as therapy, produce treatment plans or recommendations unless you review and sign off on them, or detect emotions or mental states.
- Records stay confidential. Records and communications may be disclosed only as Illinois's Mental Health and Developmental Disabilities Confidentiality Act requires.
- The penalty. Up to $10,000 per violation, set by the state licensing department.
Texas: a disclosure when AI is part of care
Texas HB 149, the Texas Responsible Artificial Intelligence Governance Act, took effect January 1, 2026. It says that if an AI system is used in relation to a health care service or treatment, the provider must give the law's AI disclosure to the patient or their personal representative. The disclosure is due no later than the date the service is first provided, except in an emergency. It must be clear and in plain language, with no dark patterns. How far "in relation to" reaches, for example AI that only drafts your notes, is a question for your counsel.
Other states are writing rules too. Check your own state board before you rely on this list.
Five steps before you paste
- Find out if HIPAA applies to you. If it does, do not put client health information into an AI service without a BAA.
- Check your state. In Illinois, get written notice and consent before using AI on recorded or transcribed sessions. In Texas, give the AI disclosure when AI is used in relation to their care.
- Send only what the task needs. To fix grammar in a note, the AI does not need the client's name, birthday or town.
- Take identifiers out, then read what is left. Software can find names and numbers. Only you can spot the detail that makes a client easy to recognize.
- Write it down. Name the AI tools your practice allows, and what may go into each.
What KeptPDF does, and what it does not
Anonymize for AI swaps identifiers for numbered placeholders like [PERSON_1]. It runs in your browser, and the file is not uploaded to KeptPDF. Here is how it lines up with the Safe Harbor list.
It looks for: names, addresses and ZIP codes, dates, ages 90 and over, phone numbers, emails, SSNs, medical record numbers, insurance and member IDs, account numbers, driver's license and other license numbers, vehicle VINs, device and serial numbers, URLs and IP addresses.
It does not look for: fax numbers as their own type, license plates, finger or voice prints, or faces and photos. It reads text, not pictures. And no software can judge the last Safe Harbor item, "any other unique" detail, or the actual-knowledge test.
It does not certify anything. KeptPDF does not decide whether your text is de-identified under HIPAA. It finds likely identifiers and swaps them. It can miss some. Using it does not, on its own, meet Safe Harbor or Expert Determination. You review the result, and the HIPAA decision stays with you.
- Open Anonymize for AI and drop in a PDF or Word file, or paste your note.
- Review what it found. Add anything it missed, like a town, a school or an employer.
- Copy the anonymized text into the AI tool your practice allows.
- Put the real values back. Paste the AI's answer into the restore box. To restore later, click Save case key first. You can lock the key file with a passphrase.
One honest note. The anonymized text you paste does go to the AI company. Swapping identifiers lowers what is exposed. It does not replace a BAA, client consent, or your own judgment.
Sources
Primary sources only. Outside the short quotes, we summarize in our own words.
- HHS: Guidance Regarding Methods for De-identification of Protected Health Information
- HHS: Guidance on HIPAA and Cloud Computing
- HHS: Covered Entities and Business Associates
- Illinois General Assembly: Public Act 104-0054, Wellness and Oversight for Psychological Resources Act
- Texas Legislature: HB 149, enrolled text (see section 552.051)
- OpenAI: Enterprise privacy at OpenAI
This is not legal or clinical advice. It is a plain-English summary for general information. Talk to your counsel, your licensing board or your privacy officer before you set an AI policy.