U.S. Code » Title 42 » Chapter CHAPTER 7— SOCIAL SECURITY › Subchapter SUBCHAPTER XI— GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE SIMPLIFICATION › Part Part C— Administrative Simplification

42 U.S.C. § 1320d

Definitions

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For purposes of this part:(1) Code set

The term “code set” means any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.

(2) Health care clearinghouse

The term “health care clearinghouse” means a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements.

(3) Health care provider

The term “health care provider” includes a provider of services (as defined in section 1395x(u) of this title), a provider of medical or other health services (as defined in section 1395x(s) of this title), and any other person furnishing health care services or supplies.

(4) Health informationThe term “health information” means any information, whether oral or recorded in any form or medium, that—(A) 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(B) 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.(5) Health planThe term “health plan” means an individual or group plan that provides, or pays the cost of, medical care (as such term is defined in section 300gg–91 of this title). Such term includes the following, and any combination thereof:(A) A group health plan (as defined in section 300gg–91(a) of this title), but only if the plan—(i) has 50 or more participants (as defined in section 1002(7) of title 29); or(ii) is administered by an entity other than the employer who established and maintains the plan.(B) A health insurance issuer (as defined in section 300gg–91(b) of this title).(C) A health maintenance organization (as defined in section 300gg–91(b) of this title).(D) Parts 11 So in original. Probably should be “Part”. A, B, C, or D of the Medicare program under subchapter XVIII.(E) The medicaid program under subchapter XIX.(F) A Medicare supplemental policy (as defined in section 1395ss(g)(1) of this title).(G) A long-term care policy, including a nursing home fixed indemnity policy (unless the Secretary determines that such a policy does not provide sufficiently comprehensive coverage of a benefit so that the policy should be treated as a health plan).(H) An employee welfare benefit plan or any other arrangement which is established or maintained for the purpose of offering or providing health benefits to the employees of 2 or more employers.(I) The health care program for active military personnel under title 10.(J) The veterans health care program under chapter 17 of title 38.(K) The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), as defined in section 1072(4) of title 10.(L) The Indian health service program under the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.).(M) The Federal Employees Health Benefit Plan under chapter 89 of title 5.(6) Individually identifiable health informationThe term “individually identifiable health information” means any information, including demographic information collected from an individual, that—(A) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and(B) 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—(i) identifies the individual; or(ii) with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.(7) Standard

The term “standard”, when used with reference to a data element of health information or a transaction referred to in section 1320d–2(a)(1) of this title, means any such data element or transaction that meets each of the standards and implementation specifications adopted or established by the Secretary with respect to the data element or transaction under sections 1320d–1 through 1320d–3 of this title.

(8) Standard setting organization

The term “standard setting organization” means a standard setting organization accredited by the American National Standards Institute, including the National Council for Prescription Drug Programs, that develops standards for information transactions, data elements, or any other standard that is necessary to, or will facilitate, the implementation of this part.

(9) Operating rules

The term “operating rules” means the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications as adopted for purposes of this part.

(Aug. 14, 1935, ch. 531, title XI, § 1171, as added Pub. L. 104–191, title II, § 262(a), Aug. 21, 1996, 110 Stat. 2021; amended Pub. L. 107–105, § 4, Dec. 27, 2001, 115 Stat. 1007; Pub. L. 111–5, div. A, title XIII, § 13102, Feb. 17, 2009, 123 Stat. 242; Pub. L. 111–148, title I, § 1104(b)(1), Mar. 23, 2010, 124 Stat. 146.)Editorial NotesReferences in Text

The Indian Health Care Improvement Act, referred to in par. (5)(L), is Pub. L. 94–437, Sept. 30, 1976, 90 Stat. 1400, which is classified principally to chapter 18 (§ 1601 et seq.) of Title 25, Indians. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of Title 25 and Tables.

Prior Provisions

A prior section 1171 of act Aug. 14, 1935, was classified to section 1320c–20 of this title prior to repeal by Pub. L. 97–35.

Amendments

2010—Par. (9). Pub. L. 111–148 added par. (9).

2009—Par. (5)(D). Pub. L. 111–5 substituted “C, or D” for “or C”.

2001—Par. (5)(D). Pub. L. 107–105 substituted “Parts A, B, or C” for “Part A or part B”.

Statutory Notes and Related SubsidiariesEffective Date of 2010 Amendment

Pub. L. 111–148, title I, § 1105, Mar. 23, 2010, 124 Stat. 154, provided that: “This subtitle [subtitle B (§§ 1101–1105) of title I of Pub. L. 111–148, enacting subchapter I of chapter 157 of this title, amending this section and sections 1320d–2 and 1395y of this title, enacting provisions set out as a note under section 1320d–2 of this title, and amending provisions set out as a note under this section] shall take effect on the date of enactment of this Act [Mar. 23, 2010].”

Purpose

Pub. L. 104–191, title II, § 261, Aug. 21, 1996, 110 Stat. 2021, as amended by Pub. L. 111–148, title I, § 1104(a), Mar. 23, 2010, 124 Stat. 146, provided that: “It is the purpose of this subtitle [subtitle F (§§ 261–264) of title II of Pub. L. 104–191, enacting this part, amending sections 242k and 1395cc of this title, and enacting provisions set out as a note under section 1320d–2 of this title] to improve the Medicare program under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], the medicaid program under title XIX of such Act [42 U.S.C. 1396 et seq.], and the efficiency and effectiveness of the health care system, by encouraging the development of a health information system through the establishment of uniform standards and requirements for the electronic transmission of certain health information and to reduce the clerical burden on patients, health care providers, and health plans.”

Notes of Decisions
Cited in 526 cases (220 in the last 5 years), 2003–2026 · leading case: Cooney v. Chicago Pub. Schs., 943 N.E.2d 23 (Ill. App. Ct. 2010).
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Cooney v. Chicago Pub. Schs., 943 N.E.2d 23 (Ill. App. Ct. 2010). · cites it 14× “42 U.S.C. §1320d- 2(a)(2)(C) (covered transactions include “[e]nrollment and disenrollment in a health plan”); 45 C.”
Tyquan Stewart v. Parkview Hosp., 940 F.3d 1013 (7th Cir. 2019). · cites it 3× “The district court concluded that the statute provides no pri‐ vate right of action and accordingly entered judgment for the medical defendants on that basis.”
Bayne v. Provost, 359 F. Supp. 2d 234 (N.D.N.Y. 2005). · cites it 6× “See 42 U.S.C. § 1320d (definitions). Health information means “any information, whether oral or recorded in any form or medium, [which may include electronic] that is created or received by health care provider[s] .”
Johnson v. Quander, 370 F. Supp. 2d 79 (D.D.C. 2005). · cites it 4× “Code § 22-4151, which was enacted by the District of Columbia to implement in the District of Columbia the objectives of the DNA Act, violate the Fourth and Fifth Amendments to the United States Constitution; the Ex Post Facto Clauses of Article 1, sections 9 and 10 of the…”
Law v. Zuckerman, 307 F. Supp. 2d 705 (D. Maryland 2004). · cites it 3× “§ 1320d-7(a)(2)(B)(re-ferring back to the Historical and Statutory notes to 42 U.S.C § 1320d — 2); 45 C.F.R. § 160.203 .”
In Re Nickelodeon Consum. Privacy Litig., 827 F.3d 262 (3rd Cir. 2016). “42 U.S.C. § 1320d(6). 155 . Pub. L. No. 105-277, Div.”
In Re the Matter of the Est. of Ashworth, Robert Harrison, 2024 CO 39 (Colo. 2024). “42 U.S.C. §§ 1320d to 1320d-9. HIPAA does protect medical records, but it includes an exception that allows for disclosure in accordance with a court order.”
Pac. Radiation Oncology v. the Queen's Med. Ctr., 810 F.3d 631 (9th Cir. 2015). “During discovery of its unfair trade practices case, Appellant Pacific Radiation Oncology, LLC (PRO) sought injunctive relief against Appellee The Queen’s Medical Center (QMC) arguing that QMC’s review and use of patient records violated the Health Insurance Portability and…”
Giangiulio v. Ingalls Mem'l Hosp., 850 N.E.2d 249 (Ill. App. Ct. 2006). · cites it 3× “42 U.S.C. § 1320d — 7(a)(1) (2000). The intended purpose of section 1320d — 7(a)(1) of Title 42 of the United States Code has been implemented by section 160.”
Christopher Payne v. Jahal Taslimi, 998 F.3d 648 (4th Cir. 2021). “42 U.S.C. § 1320d- 10 The circuits that have found a right to privacy in this context have done so by finding that privacy right to be “completely different” than the rights “extinguished” by Hudson’s reasonable-expectation-of-privacy test.”
In Re Collins, 286 S.W.3d 911 (Tex. 2009). · cites it 2× “1936 (1996) (codified as amended at 42 U.S.C. §§ 1320d to 1320d-8 (2006)), because section 74.”
Zani v. Rite Aid Headquarters Corp., 246 F. Supp. 3d 835 (S.D.N.Y. 2017). · cites it 2× “Rite Aid used a vendor that it designated as a “business associate” of Rite Aid, for purposes of sharing protected information under the Health Insurance Portability and Accountability Act (“HI-PAA”), 42 U.S.C. §§ 1320d, et seq. Def. Rule 56.”
Show all 526 citing cases →
— 42 U.S.C. § 1320d(2) — 1 case
United States v. WR Grace, 401 F. Supp. 2d 1093 (D. Mont. 2005).
— 42 U.S.C. § 1320d(3) — 6 cases
Abbott v. Texas Dep't of Mental Health & Mental Retardation, 212 S.W.3d 648 (Tex. App. 2006).
Nitta v. Dep't of Human Servs.., 520 P.3d 241 (Haw. 2022).
Andrew Cooley v. Susan Camicia (Wash. Ct. App. 2017).
Greg Abbott, Attorney Gen. of the State of Texas v. Texas Dep't of Mental Health & Mental Retardation (Tex. App. 2006).
Greg Abbott, Attorney Gen. of the State of Texas v. Texas Dep't of Mental Health & Mental Retardation (Tex. App. 2006).
— 42 U.S.C. § 1320d(4) — 22 cases
Kenneth Wilson v. UnitedHealthcare Ins. Co, 27 F.4th 228 (4th Cir. 2022).
Bayne v. Provost, 359 F. Supp. 2d 234 (N.D.N.Y. 2005). “See 42 U.S.C. § 1320d (definitions). Health information means “any information, whether oral or recorded in any form or medium, [which may include electronic] that is created or received by health care provider[s] .”
Mark S. Mais v. Gulf Coast Collection Bureau, Inc., 768 F.3d 1110 (11th Cir. 2014).
Zani v. Rite Aid Headquarters Corp., 246 F. Supp. 3d 835 (S.D.N.Y. 2017). “Rite Aid used a vendor that it designated as a “business associate” of Rite Aid, for purposes of sharing protected information under the Health Insurance Portability and Accountability Act (“HI-PAA”), 42 U.S.C. §§ 1320d, et seq. Def. Rule 56.”
Zachary Baisden v. Credit Adjustments, Inc., 813 F.3d 338 (6th Cir. 2016).
— 42 U.S.C. § 1320d(4)(B) — 1 case
Gallo v. Unknown No. of Identity Thieves, 254 F. Supp. 3d 1096 (N.D. Cal. 2017).
— 42 U.S.C. § 1320d(4)(b) — 1 case
State v. Sanchez, 306 P.3d 935 (Wash. 2013).
— 42 U.S.C. § 1320d(6) — 39 cases
Cooney v. Chicago Pub. Schs., 943 N.E.2d 23 (Ill. App. Ct. 2010). “42 U.S.C. §1320d- 2(a)(2)(C) (covered transactions include “[e]nrollment and disenrollment in a health plan”); 45 C.”
In Re Nickelodeon Consum. Privacy Litig., 827 F.3d 262 (3rd Cir. 2016). “42 U.S.C. § 1320d(6). 155 . Pub. L. No. 105-277, Div.”
Terrell v. Main Line Health, Inc., 320 F. Supp. 3d 644 (E.D. Pa. 2018).
D.L. v. Sheppard Pratt Health Sys., 465 Md. 339 (Md. 2019).
Abbott v. Texas Dep't of Mental Health & Mental Retardation, 212 S.W.3d 648 (Tex. App. 2006).
— 42 U.S.C. § 1320d(6)(A) — 1 case
Strong v. LifeStance Health Grp. Inc. (D. Ariz. 2025).
— 42 U.S.C. § 1320d(6)(B) — 3 cases
South Carolina Med. Ass'n v. Thompson, 327 F.3d 346 (4th Cir. 2003).
Hartley v. Univ. of Chicago Med. Ctr. (N.D. Ill. 2025).
Am. Hosp. Ass'n v. Becerra (N.D. Tex. 2024).
— 42 U.S.C. § 1320d(6)(B)(i) — 1 case
Bayne v. Provost, 359 F. Supp. 2d 234 (N.D.N.Y. 2005). “See 42 U.S.C. § 1320d (definitions). Health information means “any information, whether oral or recorded in any form or medium, [which may include electronic] that is created or received by health care provider[s] .”
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