Can therapists fax client records? What the ACA, AAMFT and NASW codes say

Therapists can fax client records: CMS's HIPAA fact sheet says providers can use fax machines to communicate with other professionals and patients as long as they use safeguards, and the ACA, AAMFT and NASW codes each add conditions for records sent through any medium, from written permission before records go to third parties to checking the fax number first.

Can therapists fax client records?

Therapists can fax client records under HIPAA when the practice keeps the safeguards 45 CFR 164.530(c) requires: administrative, technical and physical safeguards that protect the privacy of health information. Each professional code then sets conditions for records sent through any medium. ACA's ethics page calls the 2014 ACA Code the current version, and the AAMFT Code on aamft.org is the revision effective January 1, 2026.

The table sets the three codes side by side on records sent by any medium, each in its own terms.

What does NASW's technology standard say about fax numbers?

NASW's technology Standard 3.07 speaks to fax numbers through its interpretation, which lists having the correct fax number, e-mail address or telephone number among the ways to manage risk when client records are shared electronically and asks social workers to double-check addresses before sending. The standard's own text sets the duty behind those checks: reasonable steps to protect confidentiality whenever client information is shared electronically (NASW Standards for Technology).

Three more checks in the interpretation fit a fax: social workers should have the client's informed consent before the record leaves the organization, send only what is required, and tell the recipient the contents are confidential and not to be shared further, a notice a cover page can carry (what a HIPAA fax cover sheet must say). The two number checks are the guard against a misdial (whether a misdirected fax is a HIPAA breach).

Do the ethics codes require encryption?

ACA Code H.2.d and NASW Code 1.07(m) name encryption, and AAMFT Standard 6.5 asks for technology that meets professional and legal standards: H.2.d asks for current encryption standards in technology-based communications, 1.07(m) lists encryption, firewalls and passwords as safeguards for electronic communications such as e-mail, and Standard 6.5 covers documentation an MFT generates, transmits or keeps electronically. NASW's technology Standard 2.08 reaches the vendors too. Social workers who submit claims electronically take reasonable steps so business associates use proper encryption (whether you need a BAA with your online fax service).

Do therapists have to tell clients about the risks of sending records electronically?

Under the NASW Code, social workers should tell clients about a disclosure and its potential consequences beforehand when feasible (1.07(d)), and under the ACA and AAMFT codes, counselors and MFTs get written permission before records leave, apart from the exceptions each code lists. The interpretation of NASW's Standard 3.07 adds informed consent from the client before information goes outside the organization, and NASW 1.07(b) lets a social worker disclose with the valid consent of the client or of someone legally authorized to consent for the client.

ACA's B.6.g asks for written permission before records go to legitimate third parties unless exceptions to confidentiality exist. AAMFT's Standard 2.2 asks for written authorization or waiver, unless law mandates or permits the disclosure.

How do you fax a client record under your code, step by step?

Faxing a client record under the ACA, AAMFT or NASW code takes seven steps, and each one answers a rule.

1. Confirm the permission the record needs: written permission under ACA B.6.g, written authorization or waiver under AAMFT 2.2, valid consent under NASW 1.07(b), or an authorization for psychotherapy notes under 45 CFR 164.508(a)(2).
2. Cut the record to what the recipient needs, since ACA B.2.e limits a required disclosure to essential information and NASW 1.07(c) asks for the least amount necessary.
3. Confirm the recipient's fax number, as the interpretation of NASW Standard 3.07 asks.
4. Double-check the number as entered before sending.
5. Mark the cover page confidential so the recipient knows the information should not be shared (NASW Standard 3.07; ACA B.6.g).
6. Send through technology that meets professional and legal standards (AAMFT Standard 6.5) with current encryption standards (ACA H.2.d).
7. File the delivery record with the client's record, kept secure in any medium (ACA B.6.b; AAMFT 2.5; NASW Standard 3.03).

On Fax Pigeon, every plan includes a BAA signed at sign-up, a cover sheet is optional on any fax, and every delivered fax gets delivery proof for step 7. Plans start with Basic at $4.99 a month billed annually for 200 pages sent and received.

What does HIPAA add to the codes?

HIPAA adds a safeguards rule that binds every covered provider whatever the code: 45 CFR 164.530(c) requires administrative, technical and physical safeguards, protection against intentional or unintentional disclosures that violate the Privacy Rule, and limits on incidental disclosures that come with a permitted one. CMS's HIPAA fact sheet asks providers to secure records holding protected health information so they are not readily available to people who do not need them (CMS HIPAA basics), and fax as a channel has its own page (whether faxing is HIPAA compliant).

Psychotherapy notes carry their own rule. A covered entity needs an authorization for any use or disclosure of psychotherapy notes, apart from the exceptions 164.508(a)(2) lists, whichever code the therapist follows.

When the AAMFT Code asks more than the law requires, the code itself says which standard an MFT meets: marriage and family therapists "must meet the higher standard of the AAMFT Code of Ethics."

* Fax Pigeon prices and plan terms as of October 21, 2026. Outside sources were read on October 20, 2026.