# Patient-note annotation exercise

Entirely synthetic patient, events and identifiers. No expert determination or product test has been performed.

Compare three treatments of one invented note. The worksheet illustrates review decisions, not a legal determination about a real dataset.

| Item in invented note | Why review it | Illustrative treatment |
| --- | --- | --- |
| Mara Example; MRN TEST-4821 | Name and medical-record identifier. | Remove both, rather than replacing only the visible name. |
| Seen on 14 March 2026 | Date directly related to an individual. | Retain 2026 only for a Safe Harbor review. |
| Age 93 | Age above 89. | Use the category age 90 or older. |
| Only harbour master in a small town | Distinctive context may identify the person. | Omit occupation and locality where unnecessary; assess remaining context. |
| Patient A attended on 14 March, age 93 | Masking retains multiple identifying clues. | Do not label this version de-identified. |
| Older adult discussed a routine follow-up | More general wording loses clinical detail. | Check task utility and the complete chosen method before any real release. |

## Review steps

- Record the chosen legal method: Distinguish Safe Harbor review, documented Expert Determination and ordinary masking.
- Review the complete output: Apply identifier and contextual checks to free text, all file content and relevant metadata.
- Keep the release conditions: Record the recipient, remaining information and reason the selected method is satisfied; do not invent reviewer sign-off.

## Invented original

Mara Example, MRN TEST-4821, age 93, attended on 14 March 2026. The note describes the only harbour master in a small town seeking a routine follow-up.

## Ordinary masking, insufficient by itself

Patient A, age 93, attended on 14 March 2026. The note describes the only harbour master in a small town seeking a routine follow-up.

## Reduced-detail teaching example

An adult aged 90 or older discussed a routine follow-up in 2026.

The last version is a teaching example only. This exercise does not establish that a real record meets Safe Harbor or Expert Determination.

## Source and scope

Guide: https://aona.ai/resources/guides/hipaa-de-identification-ai-patient-notes/

Source check: 21 September 2026. General information; no professional approval or installed-product result is represented.

- HHS: Methods for de-identification of PHI: https://www.hhs.gov/hipaa/for-professionals/special-topics/de-identification/index.html