Medico-Legal Guidelines Appendix A-1

Appendix A-1

Relevant HIPAA Definitions

45 C.F.R. 160.103 Definitions.

Health information means any information, whether oral or recorded in any form or medium, that:

1. Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and


2. Related to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.

1. Is created or received by a health care provider, health plan, employer, or health care clearinghouse; and


2. Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and


1. That identifies the individual; or


2. With respect to which there is a reasonable basis to believe the information can be used to identify the individual.

1. A group of records maintained by or for a covered entity that is:
   
   1. The medical records and billing records about individuals maintained by or for a covered health care provider;
   
   
   2. The enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or
   
   
   3. Used, in whole or in part, by or for the covered entity to make decision about individuals.
   
   
2. For purposes of the paragraph, the term records means any item, collection, or grouping of information that includes protected health information and is maintained, collected, used, or disseminated by or for a covered entity.

1. Except as provided in paragraph (2) of this definition, that is:
   
   1. Transmitted by electronic media;
   
   
   2. Maintained in any medium described in the definition of electronic media at § 162.103 of this subchapter; or
   
   
   3. Transmitted or maintained in any other form or medium.
   
   
2. Protected health information excludes individually identifiable health information in:
   
   1. Education records covered by the Family Educational Right and Privacy Act, as amended, 20 U.S.C. 1232g;
   
   
   2. Records described at 20 U.S.C. 1232g(a)(4)(B)(iv); and
   
   
   3. Employment records held by a covered entity in its role as employer.

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