PHI De-identifier

De-identify clinical / health text to the HIPAA Safe Harbor standard (or a Limited Data Set) using the bundled, offline scripts/deidentify.py. Every run produces two things: the redacted text and an audit manifest listing what was removed, by category, plus anything that needs human review.

When to use

• "De-identify / anonymise / scrub / redact this note (or file / folder)."
• "Remove patient identifiers before I share this."
• "Make this Safe Harbor compliant" or "produce a limited data set."
• Preparing PHI-free samples for demos, test fixtures, analytics, or model prompts.

Do not use it to answer clinical questions or to claim legal certification — it is a mechanical redactor plus an audit trail for a human to verify.

How to run it

Always call the bundled script; never improvise redaction logic.

# Safe Harbor (default): writes NOTE.deid.txt + NOTE.manifest.json next to input
python scripts/deidentify.py NOTE.txt

# Limited Data Set: retains dates and city/state/ZIP, strips direct identifiers
python scripts/deidentify.py NOTE.txt --mode limited

# Inline text, machine-readable result to stdout
python scripts/deidentify.py --text "John Doe, SSN 123-45-6789" --json

# HYBRID name recall: pass the person names YOU (the agent) spotted in free prose
python scripts/deidentify.py --text "<text>" --names "Rafael Alcaraz,Ngozi Okafor" --json

# STRUCTURED / JSON input: redact by FIELD NAME (MRN, City, Employer, DOB, ...)
# Use this whenever the input is a JSON object or a key/value record — NOT free text.
python scripts/deidentify.py intake_record.json --format record --json

# ALSO emit a reversible token->value crosswalk (SENSITIVE — re-identifying)
python scripts/deidentify.py NOTE.txt --map crosswalk.json

Steps:

1. Identify the input (a file path, a folder, or inline text) and the target standard: Safe Harbor (default) or Limited Data Set (--mode limited).
2. Pick the right mode for the shape of the input. If the input is a structured record — a JSON object, or clear Field: value key/value pairs (e.g. an intake record, an API payload, an exported row) — run it with --format record. Record mode maps each field by its NAME (MRN, City, Employer, DOB, SSN, …) and redacts deterministically; free-text mode will MISS quoted/structured identifiers like "MRN": "33108876" because there is no adjacent label to anchor on. Use the default (free-text) mode only for prose. Still run the name-recall pass on any free-text field VALUES (e.g. a ChiefComplaint or Notes field that contains a person's name).
3. Name-recall pass (do this every time on free prose). Before running, read the text yourself and list every PERSON name and PLACE (city / facility) you can identify — including unusual or non-English names that a regex or the bundled lexicon would miss (e.g. "Rafael Alcaraz", "Okafor"). This is the model/agent contribution to the hybrid; you are the recall booster.
4. Run scripts/deidentify.py, passing the names from step 3 via --names "Name One,Name Two" (or a --names-file with {"names":[...], "places":[...],"orgs":[...]}). The script deterministically redacts every occurrence, tokenizes consistently, runs its guard, and writes the manifest. The script — not your paraphrase — is the auditable system of record.
5. Return the redacted text exactly as produced, and summarise the manifest: how many identifiers of each category were removed.
6. Surface needs_human_review. Names caught heuristically, and any unknown capitalised text flagged for review, are listed there — tell the user these must be verified before release, and that bare names in free prose may still be missed.
7. Only write the --map crosswalk when the user explicitly needs to re-identify later; warn that it is sensitive and must be stored securely, separately from the de-identified output.

Use as a safety net before an outbound action

Agents often carry actions that emit content — Send Email, Create Record, Post Message, Export. When an agent maker points one of those actions at this skill (e.g. an instruction like "before Send Email, de-identify the content using phi-deidentifier"), apply this skill as a gate:

1. Take the exact text about to leave the agent (e.g. the email Subject + Body, or the field values of the record).
2. De-identify it with the steps above (including the name-recall pass).
3. Populate the action's inputs from the redacted result only — never from the original text.
4. If needs_human_review is non-empty, do not fire the action; show the redacted draft plus the review items and ask the user to confirm first.
5. On success, tell the user the content was de-identified and how many identifiers were removed. Never place the --map crosswalk in the outbound content or in chat.

The maker only needs to reference this skill by name in the action's instruction; the operational steps above live here, in the skill, so they do not have to be re-written per agent.

What it removes (HIPAA Safe Harbor, 18 identifiers)

Handled deterministically by regex (high confidence): names in labelled fields and after titles, street addresses, city + state, geographic ZIP (truncated to 3 digits; restricted prefixes zeroed), all date elements finer than year, ages 90+ (aggregated), phone (US, international +country-code, and labelled formats), fax, email, URL, IP address, SSN (dashed, spaced, or labelled — including run-together digits), MRN, health-plan / account / member numbers, certificate / license / DEA / NPI numbers, device serial numbers, VIN.

As a backstop, any unlabelled digit run of 7+ characters that looks like an identifier the structured detectors couldn't anchor on (a bare account / record / SSN / device or phone number) is flagged under needs_human_review — never silently dropped, and never auto-redacted (a bare number may be a legitimate non-PHI value, so a human confirms).

Handled best-effort and flagged for review: person names in free prose. Names are caught by (a) title/label patterns ("Patient: …", "Dr. …") and (b) a bundled offline name lexicon (assets/name_lexicon.txt) that catches many bare names with no title or label — all fully local, no network or extra packages, so it works in locked-down agent sandboxes (e.g. the Copilot Studio Python container where you cannot pip install). Names not in the lexicon can still be missed and word-like names may be over-redacted, so human review of free text is required; extend the lexicon for your population. (If a runtime already ships spaCy it is used automatically as a bonus, but installation is never assumed.) City/state written without a comma or trailing ZIP may also be missed. Full-face photos and biometric identifiers are out of scope — this skill processes text only; call that out if the source contains images.

Transformations (so downstream data stays useful)

• Consistent pseudonyms: each distinct value maps to a stable token, e.g. every occurrence of the same MRN becomes [MRN-1], so linkage is preserved without exposing the value.
• Dates → year only: 03/15/1985 → [DATE:1985] (Safe Harbor keeps year).
• Ages: ≤89 retained; 90+ → [AGE:90+].
• ZIP → first 3 digits: 98104 → [ZIP:981XX]; HHS-restricted low-population prefixes → [ZIP:000].
• Limited Data Set mode keeps dates and city/state/ZIP intact while still removing names, contacts, SSN, MRN, and account numbers.

The audit manifest

NOTE.manifest.json records the mode, a per-category count summary, one entry per token with a salted hash of the original value (never the plaintext), the needs_human_review list, and explanatory notes. Use it as the evidence trail for a reviewer — it answers "what did the tool remove, and what still needs eyes?" without itself containing PHI.

Guardrails

• Never claim compliance. Report what was removed; a qualified human makes the Safe Harbor / expert-determination call.
• Never invent or "restore" content. Only redact.
• Do not paste the crosswalk into chat or co-locate it with the output; it re-identifies the data.
• Always relay needs_human_review and remind the user to review free text — regex cannot guarantee every bare name or unusual identifier is caught.
• Text only: if the source has images/scans, say so and recommend a separate image-redaction step.

References

• references/hipaa-safe-harbor.md — the 18 identifiers, ZIP/date/age rules, and Safe Harbor vs Limited Data Set, as implemented here.