Do you need patient consent to use an AI scribe?
If a tool is listening to the visit, treat it like a recording. Here is the consent conversation I tell practices to have before they turn one on.
Someone asks this on almost every demo, usually after they have already watched a note come together. Then it lands: a microphone was in the room.
I am not your lawyer, and your state might not match the next county over. What I can tell you is how practices that do this carefully talk about it, and where people get sloppy.
Treat it like a recording, because it often is
An ambient scribe listens to the visit and turns speech into a draft note. In a two-party consent state, that is close enough to “recording a conversation” that you should not wing it. One-party states are looser on the statute and not looser on professional judgment. Therapy and psychiatry add a second layer: even when the law allows you to proceed, the patient still gets to decide whether they want a device in the room.
If your counsel already wrote a recording policy for trainees, telehealth, or quality review, start there. Do not invent a separate AI policy that contradicts it.
Consent is a conversation, not a checkbox buried in intake
The practices that get fewer surprises say it out loud, in ordinary language, at the start of the first visit that uses the tool:
We use a documentation assistant that listens so I can stay with you instead of typing. It drafts the note. I read and edit that draft before anything is signed. You can ask me to turn it off for this visit, or for part of it.
That is the whole speech. If they hesitate, turn it off. You can type. You will not die.
Write down that you discussed it. “Patient informed that an ambient documentation tool would be used; agreed” is enough for most charts I have seen. If they decline, write that down too, and do not argue them into it.
A portal blurb and a signed general consent help. They do not replace saying it in the room. People skim portals. They remember what you told them while they were sitting there.
What patients usually want to know
First they want to know who hears this. Name the vendor. Say whether a human on that side can listen (most clinical scribes used for notes do not send your session out for a person to transcribe). If you have a BAA with that vendor, say you do. If you do not have a BAA, stop and get one before you turn anything on. That part is not optional.
Then they want to know whether the session trains some model. Ask your vendor in writing. Put the answer in your own words for the patient. If you cannot get a straight answer, that is your answer.
Then they want to know if they can say no. Yes. Mean it. The visit still happens.
I would not lead with encryption speeches. Patients hear “we take privacy seriously” from everyone. They want to know who is listening and whether they have a choice.
Special cases people forget
Minors. The parent who consented to treatment is not automatically the person who can consent to a recording, depending on the state and the child’s age. Ask counsel before you assume.
A second person on speaker, or a family member in the room. They did not sign your intake. Tell them the tool is on, or turn it off.
A patient who is manic, floridly psychotic, or otherwise not in a position to take this in. Use judgment. You can document later. You cannot un-record a session.
Group therapy. One yes does not cover the circle. If anyone in the group does not want it, the scribe stays off.
What I would not do
Do not hide the tool and hope nobody asks. A line in 8-point font on page six of the new-patient packet is not informed consent. A vendor marketing page is not your policy.
Nextvisit is an ambient documentation tool. It drafts. A clinician still reviews and signs. You are still asking permission for a listener in the room. You are not asking them to let a stranger write the finished chart.
If you want a starting point for counsel, give them this: we will disclose that a documentation assistant listens, we will document the patient’s choice, we will honor a no, and we will keep a BAA on file. Then let them write the actual policy. That is their job. Showing up in the room and saying it plainly is yours.