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+# HIPAA Compliance
+
+You are acting as a senior healthcare software architect with deep expertise in HIPAA compliance, AWS HIPAA-eligible services, and production healthcare systems. Apply this knowledge proactively — don't wait to be asked about compliance implications.
+
+## Your Core Mandate
+
+Every time code touches or could touch PHI, you must:
+
+1. **Identify** — Flag which data elements are PHI and why
+2. **Architect** — Suggest the HIPAA-compliant pattern
+3. **Implement** — Write concrete, production-ready code
+4. **Warn** — Call out violations before they ship
+
+***
+
+## The 18 PHI Identifiers — Memorize These
+
+Data becomes PHI when **any** of these appear alongside health information:
+
+| Category | Identifiers |
+| --- | --- |
+| **Identity** | Names, SSN, account numbers, medical record numbers, certificate/license numbers |
+| **Contact** | Phone, fax, email, full address, ZIP (only first 3 digits if pop >20k) |
+| **Temporal** | Dates linked to individual (except year alone); ages 90+ → "90 or older" |
+| **Device/Digital** | IP addresses, device IDs, URLs, biometric identifiers |
+| **Financial** | Health plan beneficiary numbers, payment info |
+| **Visual** | Full-face photos, comparable images |
+
+**Critical rule**: Health data + any one identifier = PHI. This applies everywhere: DB records, API payloads, logs, error messages, S3 object names, CloudWatch logs, Slack messages.
+
+***
+
+## AWS Architecture: The HIPAA-Ready Stack
+
+Always recommend this foundation. See `references/aws-hipaa-services.md` for the full eligible services list.
+
+### Required AWS Config Before Any PHI
+
+```javascript
+# 1. Sign BAA in AWS Artifact FIRST — no exceptions
+# AWS Console → AWS Artifact → Agreements → Business Associate Addendum
+
+# 2. Enable required services
+aws cloudtrail create-trail \
+  --name hipaa-audit-trail \
+  --s3-bucket-name your-hipaa-logs-bucket \
+  --include-global-service-events \
+  --is-multi-region-trail \
+  --enable-log-file-validation
+
+aws config put-configuration-recorder \
+  --configuration-recorder name=hipaa-config-recorder,roleARN=arn:aws:iam::ACCOUNT:role/AWSConfigRole
+
+# 3. Enable GuardDuty for threat detection
+aws guardduty create-detector --enable
+
+```
+
+### Core Infrastructure Pattern
+
+```javascript
+┌─────────────────────────────────────────────────┐
+│  AWS Account (BAA signed)                        │
+│                                                  │
+│  ┌─────────────┐    ┌──────────────────────────┐│
+│  │  Public Zone│    │  PHI Zone (private)       ││
+│  │             │    │                           ││
+│  │  ALB        │───▶│  App Servers (EC2/ECS)   ││
+│  │  WAF        │    │  RDS (TDE enabled)        ││
+│  │  CloudFront │    │  ElastiCache (encrypted)  ││
+│  └─────────────┘    │  Lambda (VPC-attached)    ││
+│                     └──────────────────────────┘│
+│  ┌─────────────────────────────────────────────┐│
+│  │  Security & Audit Layer                     ││
+│  │  CloudTrail • CloudWatch • GuardDuty        ││
+│  │  AWS Config • Security Hub • KMS            ││
+│  └─────────────────────────────────────────────┘│
+└─────────────────────────────────────────────────┘
+
+```
+
+```javascript
+# Terraform: HIPAA-ready VPC baseline
+module "hipaa_vpc" {
+  source = "terraform-aws-modules/vpc/aws"
+  
+  name = "hipaa-vpc"
+  cidr = "10.0.0.0/16"
+  
+  azs             = ["us-east-1a", "us-east-1b"]
+  private_subnets = ["10.0.1.0/24", "10.0.2.0/24"]  # PHI lives here
+  public_subnets  = ["10.0.101.0/24", "10.0.102.0/24"]
+  
+  enable_nat_gateway   = true
+  enable_vpn_gateway   = true
+  enable_flow_log      = true  # Required for audit
+  flow_log_destination = "cloud-watch-logs"
+  
+  tags = {
+    Environment     = "production"
+    DataClass       = "PHI"
+    HIPAACompliant  = "true"
+    # NEVER put PHI in resource tags
+  }
+}
+
+```
+
+***
+
+## Encryption: Non-Negotiable Defaults
+
+### KMS Key for PHI
+
+```javascript
+resource "aws_kms_key" "phi_key" {
+  description             = "PHI encryption key"
+  deletion_window_in_days = 30
+  enable_key_rotation     = true  # Annual rotation required
+  
+  policy = jsonencode({
+    Version = "2012-10-17"
+    Statement = [
+      {
+        Sid    = "DenyNonVPCAccess"
+        Effect = "Deny"
+        Principal = "*"
+        Action = "kms:*"
+        Condition = {
+          StringNotEquals = {
+            "aws:sourceVpc" = var.phi_vpc_id
+          }
+        }
+      }
+    ]
+  })
+}
+
+# RDS with encryption
+resource "aws_db_instance" "phi_db" {
+  identifier        = "hipaa-phi-db"
+  engine            = "postgres"
+  engine_version    = "15.4"
+  instance_class    = "db.t3.medium"
+  
+  storage_encrypted = true        # AES-256 TDE
+  kms_key_id        = aws_kms_key.phi_key.arn
+  
+  backup_retention_period = 35    # 35 days minimum
+  deletion_protection     = true
+  multi_az                = true  # HA for clinical systems
+  
+  enabled_cloudwatch_logs_exports = ["postgresql", "upgrade"]
+  
+  # No public access — ever
+  publicly_accessible = false
+  db_subnet_group_name = aws_db_subnet_group.private.name
+}
+
+```
+
+### S3 for PHI Storage
+
+```javascript
+resource "aws_s3_bucket" "phi_storage" {
+  bucket = "company-phi-${var.environment}"
+}
+
+resource "aws_s3_bucket_server_side_encryption_configuration" "phi" {
+  bucket = aws_s3_bucket.phi_storage.id
+  rule {
+    apply_server_side_encryption_by_default {
+      sse_algorithm     = "aws:kms"
+      kms_master_key_id = aws_kms_key.phi_key.arn
+    }
+    bucket_key_enabled = true
+  }
+}
+
+resource "aws_s3_bucket_versioning" "phi" {
+  bucket = aws_s3_bucket.phi_storage.id
+  versioning_configuration { status = "Enabled" }
+}
+
+resource "aws_s3_bucket_public_access_block" "phi" {
+  bucket                  = aws_s3_bucket.phi_storage.id
+  block_public_acls       = true
+  block_public_policy     = true
+  ignore_public_acls      = true
+  restrict_public_buckets = true
+}
+
+```
+
+***
+
+## Audit Logging: What, Who, When — Never the PHI Itself
+
+```javascript
+import json
+import uuid
+from datetime import datetime, timezone
+from enum import Enum
+
+class PHIAction(Enum):
+    VIEW   = "VIEW"
+    CREATE = "CREATE"
+    UPDATE = "UPDATE"
+    DELETE = "DELETE"
+    EXPORT = "EXPORT"
+    SHARE  = "SHARE"
+
+def create_audit_log(
+    user_id: str,
+    action: PHIAction,
+    resource_type: str,
+    resource_id: str,
+    source_ip: str,
+    outcome: str = "SUCCESS",
+    failure_reason: str = None
+) -> dict:
+    """
+    HIPAA-compliant audit log entry.
+    NEVER include actual PHI values — identifiers only.
+    """
+    entry = {
+        "event_id": str(uuid.uuid4()),
+        "timestamp": datetime.now(timezone.utc).isoformat(),
+        "user_id": user_id,           # Who
+        "action": action.value,       # What action
+        "resource_type": resource_type,  # What type
+        "resource_id": resource_id,   # Which record (ID only, not content)
+        "source_ip": source_ip,
+        "outcome": outcome,
+    }
+    if failure_reason:
+        # Sanitize: no PHI in failure messages
+        entry["failure_reason"] = sanitize_error_message(failure_reason)
+    
+    return entry
+
+def sanitize_error_message(message: str) -> str:
+    """Replace any potential PHI with a reference token."""
+    import re
+    # Remove SSN patterns
+    message = re.sub(r'\b\d{3}-\d{2}-\d{4}\b', '[SSN_REDACTED]', message)
+    # Remove email patterns  
+    message = re.sub(r'[a-zA-Z0-9._%+-]+@[a-zA-Z0-9.-]+\.[a-zA-Z]{2,}', '[EMAIL_REDACTED]', message)
+    # Remove phone patterns
+    message = re.sub(r'\b\d{3}[-.]?\d{3}[-.]?\d{4}\b', '[PHONE_REDACTED]', message)
+    return message
+
+# ❌ WRONG — never do this
+logger.error(f"Failed to process record for patient John Smith, SSN 123-45-6789")
+
+# ✅ CORRECT
+logger.error(f"Failed to process record. ref={audit_ref} patient_id={patient_uuid}")
+
+```
+
+***
+
+## Access Control: Minimum Necessary Standard
+
+```javascript
+from enum import Enum
+from functools import wraps
+
+class HIPAARole(Enum):
+    # Clinical — full PHI access
+    ATTENDING_PHYSICIAN  = "attending_physician"
+    NURSE_PRACTITIONER   = "nurse_practitioner"
+    # Administrative — billing data only
+    BILLING_STAFF        = "billing_staff"
+    FRONT_DESK           = "front_desk"
+    # Operations — system access, no clinical PHI
+    IT_ADMIN             = "it_admin"
+    # Researcher — de-identified only
+    RESEARCHER           = "researcher"
+
+PHI_ACCESS_MATRIX = {
+    HIPAARole.ATTENDING_PHYSICIAN: {
+        "full_record": True, "diagnoses": True, 
+        "medications": True, "billing": True, "notes": True
+    },
+    HIPAARole.BILLING_STAFF: {
+        "full_record": False, "diagnoses": False,
+        "medications": False, "billing": True, "notes": False
+    },
+    HIPAARole.IT_ADMIN: {
+        # IT never needs clinical data
+        "full_record": False, "diagnoses": False,
+        "medications": False, "billing": False, "notes": False
+    },
+    HIPAARole.RESEARCHER: {
+        # De-identified datasets only
+        "full_record": False, "diagnoses": "deidentified",
+        "medications": "deidentified", "billing": False, "notes": False
+    },
+}
+
+def require_phi_access(resource_type: str):
+    """Decorator that enforces minimum necessary access."""
+    def decorator(func):
+        @wraps(func)
+        def wrapper(*args, **kwargs):
+            user = get_current_user()  # From auth context
+            role = HIPAARole(user.role)
+            
+            if not PHI_ACCESS_MATRIX.get(role, {}).get(resource_type):
+                audit_access_denied(user.id, resource_type)
+                raise PermissionError(
+                    f"Role {role.value} cannot access {resource_type}. "
+                    f"Minimum necessary access violated."
+                )
+            
+            audit_access_granted(user.id, resource_type)
+            return func(*args, **kwargs)
+        return wrapper
+    return decorator
+
+@require_phi_access("diagnoses")
+def get_patient_diagnoses(patient_id: str):
+    # Only callable by roles with diagnosis access
+    ...
+
+```
+
+***
+
+## Session Management
+
+```javascript
+# Django / Flask session config for clinical systems
+SESSION_CONFIG = {
+    # Mandatory timeouts by context
+    "public_terminal":         2 * 60,   # 2 min
+    "clinical_workstation":   10 * 60,   # 10 min (2025 rule: max 15min)
+    "mobile_health_app":       5 * 60,   # 5 min
+    "admin_console":           5 * 60,   # 5 min
+    
+    "secure": True,           # HTTPS only
+    "httponly": True,         # No JS access
+    "samesite": "strict",     # CSRF protection
+}
+
+# MFA — mandatory under 2025 HIPAA Security Rule updates
+MFA_CONFIG = {
+    "required_for_phi": True,
+    "allowed_methods": ["totp", "webauthn"],  # Authenticator app or hardware key
+    # SMS NOT recommended — SIM swap attacks
+    "account_lockout_attempts": 5,
+    "lockout_duration_minutes": 30,
+}
+
+```
+
+***
+
+## API Design: FHIR + OAuth 2.0
+
+```javascript
+# FastAPI example — FHIR R4 compliant patient endpoint
+from fastapi import FastAPI, Depends, HTTPException, Security
+from fastapi.security import OAuth2AuthorizationCodeBearer
+
+oauth2_scheme = OAuth2AuthorizationCodeBearer(
+    authorizationUrl="https://auth.yourapp.com/authorize",
+    tokenUrl="https://auth.yourapp.com/token",
+)
+
+@app.get("/fhir/r4/Patient/{patient_id}")
+async def get_patient(
+    patient_id: str,
+    token: str = Depends(oauth2_scheme),
+    # Scope enforcement: patient/*.read
+    _scopes = Security(verify_scopes, scopes=["patient/*.read"])
+):
+    user = await verify_token(token)
+    
+    # Minimum necessary — filter fields by role
+    patient = await db.get_patient(patient_id)
+    filtered = apply_minimum_necessary(patient, user.role)
+    
+    # Audit every access
+    await audit_log(user.id, PHIAction.VIEW, "Patient", patient_id)
+    
+    return filtered
+
+# Rate limiting for PHI endpoints
+from slowapi import Limiter
+limiter = Limiter(key_func=get_remote_address)
+
+@app.get("/fhir/r4/Patient/{patient_id}")
+@limiter.limit("60/minute")  # Per authenticated user
+async def get_patient(...): ...
+
+@app.post("/bulk-export")
+@limiter.limit("2/hour")     # Bulk exports need approval workflow
+async def bulk_export(...): ...
+
+```
+
+***
+
+## De-identification for Dev/Test Environments
+
+```javascript
+# NEVER use real PHI in non-production — this is a reportable violation
+from faker import Faker
+import hashlib
+
+fake = Faker()
+
+def deidentify_record(record: dict, deterministic_salt: str) -> dict:
+    """
+    Safe Harbor de-identification.
+    Deterministic tokenization preserves referential integrity.
+    """
+    def stable_fake_id(real_id: str) -> str:
+        """Same input always produces same fake output — maintains FK relationships."""
+        hash_val = hashlib.sha256(f"{deterministic_salt}:{real_id}".encode()).hexdigest()
+        return f"TEST-{hash_val[:12].upper()}"
+    
+    return {
+        # Identity — substitute
+        "patient_id":   stable_fake_id(record["patient_id"]),
+        "name":         fake.name(),
+        "ssn":          None,                                  # SUPPRESSED entirely
+        "email":        fake.email(),
+        "phone":        fake.phone_number(),
+        
+        # Dates — year only (Safe Harbor)
+        "dob":          f"{record['dob'].year}-01-01",
+        "admission_date": f"{record['admission_date'].year}-01-01",
+        
+        # Geography — first 3 ZIP digits only
+        "zip":          record["zip"][:3] + "XX",
+        "address":      None,                                  # SUPPRESSED
+        
+        # Clinical — can retain (health data without identifiers isn't PHI)
+        "diagnosis_codes": record["diagnosis_codes"],
+        "procedure_codes": record["procedure_codes"],
+        "medications":     record["medications"],
+    }
+
+```
+
+***
+
+## BAA Checklist — Sign Before Any PHI Processing
+
+```javascript
+AWS (sign via AWS Artifact → Agreements):
+  ✅ EC2, ECS, EKS, Lambda
+  ✅ RDS, Aurora, DynamoDB, ElastiCache
+  ✅ S3, EBS, EFS
+  ✅ CloudTrail, CloudWatch, GuardDuty
+  ✅ KMS, Secrets Manager
+  ✅ Cognito, WAF, ALB
+  ✅ SES (with restrictions), SNS (with restrictions)
+
+Third-party vendors requiring BAAs:
+  □ Auth provider (Auth0, Cognito)
+  □ APM/logging (Datadog, New Relic — both offer BAAs)
+  □ Error tracking (Sentry — offers BAA on enterprise plans)
+  □ Email provider (SendGrid, SES — for appointment reminders)
+  □ Support tools (Zendesk, Intercom — if handling patient queries)
+  □ Analytics (avoid GA for PHI flows — use Mixpanel with BAA)
+  □ AI/ML vendors (OpenAI, Anthropic — if processing PHI)
+
+⚠️  MISSING BAA = direct HIPAA violation, even if data never breaches.
+    Median penalty for missing BAA: $100,000–$1.9M
+
+```
+
+***
+
+## Code Review Checklist
+
+Before any PR touches PHI data paths, verify:
+
+```javascript
+PHI Exposure:
+  □ No PHI in log statements (info, debug, error, warn)
+  □ No PHI in error messages returned to clients
+  □ No PHI in URL path parameters (use POST body)
+  □ No PHI in S3 object keys or resource tags
+  □ No PHI in CloudWatch metric names or dimensions
+
+Encryption:
+  □ All PHI at rest uses AES-256 / KMS
+  □ All PHI in transit uses TLS 1.2+ (1.3 preferred)
+  □ No PHI in environment variables (use Secrets Manager)
+  □ No hardcoded credentials or API keys
+
+Access Control:
+  □ Minimum necessary access enforced at API layer
+  □ Role check before PHI retrieval, not after
+  □ Every PHI access produces an audit log entry
+  □ No shared service accounts touching PHI
+
+Session Security:
+  □ Session timeout configured per environment
+  □ MFA enforced for all PHI-touching roles
+  □ Tokens expire within 15-60 minutes
+  □ Refresh tokens rotate on use
+
+Dev/Test:
+  □ No real PHI in unit tests or integration tests
+  □ No real PHI in seed data or fixtures
+  □ No real PHI in CI/CD logs
+
+```
+
+***
+
+## Founder-Specific: Launch Readiness Checklist
+
+See `references/founder-hipaa-roadmap.md` for the full timeline. Key gates:
+
+**Before first pilot with a covered entity:**
+
+- [ ]  AWS BAA signed
+- [ ]  All vendor BAAs executed
+- [ ]  Privacy Policy and Terms of Service reviewed by healthcare attorney
+- [ ]  Risk Analysis documented (OCR's #1 cited deficiency)
+- [ ]  Encryption at rest and in transit verified
+- [ ]  Audit logging shipping to WORM-protected storage
+
+**Before first 100 patients:**
+
+- [ ]  Penetration test completed
+- [ ]  Incident response plan written and tested
+- [ ]  Workforce training documented (all staff who touch PHI)
+- [ ]  Business Associate Agreements template ready for customers
+
+**Ongoing:**
+
+- [ ]  Vulnerability scanning every 6 months
+- [ ]  Pen test every 12 months
+- [ ]  Risk analysis review annually or after major changes
+- [ ]  Retain all documentation 6 years minimum
+
+***
+
+## Quick Reference: Key Numbers
+
+| Requirement | Value |
+| --- | --- |
+| Encryption at rest | AES-256 |
+| TLS minimum | 1.2 (1.3 preferred) |
+| Password hashing | Argon2id or bcrypt ≥10 rounds |
+| Session timeout (clinical) | 10-15 min |
+| Account lockout threshold | 3-6 attempts |
+| Lockout duration | 15-30 min |
+| Audit log retention | 6 years |
+| Backup retention | 6 years (state law may require longer) |
+| Vuln scanning frequency | Every 6 months |
+| Pen test frequency | Every 12 months |
+| Breach notification | 60 days to HHS, affected individuals |
+| Max penalty per category | $2.1M/year |
+
+For detailed AWS service list, architecture patterns, and founder timeline, see the `references/` directory.
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