Health information sent to an external AI vendor without the contractual or legal basis the law requires

Send identifiable health data only to AI endpoints registered with a signed BAA or processing agreement and retention and training off; otherwise de-identify first.

A single client factory for model, embedding and transcription calls that handle health information: it looks the endpoint up in a vendor register and refuses to return a client unless the register shows the required contract (business associate agreement, or a processing agreement barring further disclosure) and the endpoint is the covered deployment with data retention and training use turned off. Call sites that cannot meet that de-identify or redact the record before building the prompt, or check a recorded patient authorization for that use. Keep the vendor register in the repository so reviewers can match each AI endpoint to its legal basis, and never route health data into marketing or other non-care generation.

Where it goes: 6 API calls and integrations, 3 config and feature flags, 7 prompt construction, 12 repository artifacts.

What reviewers look for: on every path from a patient record, FHIR read or clinical note to a model API, either a vendor-register check (baa_signed, processing_agreement, zero_data_retention) bound to the endpoint actually called, a recorded authorization check, or a deidentify / redact_phi step before the prompt is built; no health data sent to a general consumer endpoint or an account with training or retention left on, and no diagnosis or medication fields in marketing prompts.

client = OpenAI()
resp = client.chat.completions.create(model='gpt-4o', messages=[
    {'role': 'user', 'content': f'Summarize: {patient.clinical_note}'}])

VENDORS = load_yaml('vendors/ai_vendors.yaml')   # baa_signed, zero_data_retention per endpoint

def phi_client(name: str) -> tuple[AzureOpenAI, str]:
    v = VENDORS[name]
    if not (v['baa_signed'] and v['zero_data_retention']):
        raise PermissionError(f'{name} is not cleared for PHI')
    client = AzureOpenAI(azure_endpoint=v['endpoint'], api_key=os.environ['AZURE_OPENAI_KEY'],
                         api_version=v['api_version'])
    return client, v['deployment']

client, deployment = phi_client('azure-openai-hipaa')
resp = client.chat.completions.create(model=deployment, messages=[
    {'role': 'user', 'content': f'Summarize: {patient.clinical_note}'}])

Engineering guidance, not legal advice. Each provision below may add its own details (a cadence, a deadline, a required notice element): open it for those.