The short answer
Progress notes are part of the medical record: diagnosis, symptoms, treatment, session times, and progress. Psychotherapy notes are a therapist's separate notes analyzing session content, kept apart from the record. HIPAA gives psychotherapy notes extra protection, requires authorization for most disclosures, and excludes them from a client's right of access.
What's the difference?
Under HIPAA, psychotherapy notes are notes a mental health professional records to document or analyze the contents of a counseling session, kept separate from the rest of the medical record (45 CFR 164.501). Everything else is part of the regular record, including what most therapists call progress notes.
| Progress notes | Psychotherapy notes | |
|---|---|---|
| Where kept | In the medical record | Separate from the record |
| Contents | Diagnosis, symptoms, functional status, treatment plan, interventions, progress, session times, test results, medications | The therapist's analysis and impressions of session content |
| Needed for billing | Yes | No |
| Client's right of access | Yes | No, though you may choose to share |
| Disclosure | Treatment, payment, and operations rules apply | Authorization generally required |
What can't go in psychotherapy notes?
HHS lists what the definition excludes: medication prescribing and monitoring, session start and stop times, treatment modalities and frequencies, clinical test results, and summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress. See HHS's explanation.
In other words, anything a payer would need lives in the progress note.
Who can see psychotherapy notes?
- Disclosure generally requires the client's authorization, even for treatment by another provider, under 45 CFR 164.508(a)(2). Exceptions include disclosures required by law, such as mandated reporting.
- Clients don't have a HIPAA right to access them, per HHS's guidance on access. You can choose to share them.
- Payers can't require them as a condition of payment. They can ask for progress notes and the record.
Do you need to keep psychotherapy notes?
No. Many therapists don't keep them at all. If you do, they only get special protection when kept separate from the record. Notes stored in the same field as your progress note are part of the record.
State laws can add more protection or access rights. Check yours.
How ValorWell handles this
ValorWell's EHR is built around the documentation therapists need for care and clean claims, with AI-assisted progress notes. Whether you also keep separate psychotherapy notes is a clinical decision for you, within HIPAA and your state's rules. ValorWell's billing uses the progress note, not psychotherapy notes.
Important limits
- State law can be stricter than HIPAA. Some states give clients broader access or add protections.
- Records requests and subpoenas have their own rules; get advice before releasing records you're unsure about.
- This isn't legal advice. For specific situations, contact your licensing board or a health law attorney.