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Feature ID: CL-30
Status: 📝 Planned
Spec Reference: CL-30-psychotherapy-notes-protection.md
Last Updated: 2026-02-24

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Overview

CL-30 adds HIPAA-aligned protection for psychotherapy notes: separate storage, author-only access by default, explicit authorization for disclosure, and exclusion from medical record and FHIR export unless authorized. Integrations are within CL (CL-04, CL-11, CL-20, CL-16) and PF (PF-01); no cross-core integration.

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Integration Points (from Spec)

DependencyPatternPurpose
PF-01 (Organizations & Sites)DirectTenant context; RLS and audit
CL-04 (Progress notes)InternalUX distinction: psychotherapy note vs standard progress note; link or separate list in chart
CL-11 (Consent/authorization)InternalPsychotherapy authorization is separate from general consent; document in CL-11 disclosure log when disclosed
CL-20 (Medical record export)InternalExclude psychotherapy notes from export unless authorization present for that request
CL-16 (FHIR export)InternalExclude psychotherapy notes from FHIR export unless authorized

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API / Data Contracts

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Data (CL internal)

  • cl_psychotherapy_notes: New table; author-only RLS; content encrypted at rest (NFR-1).
  • cl_psychotherapy_authorizations: Patient authorizations for disclosure; linked to notes via cl_psychotherapy_authorization_notes.
  • Export contract: CL-20 and CL-16 export logic MUST exclude rows from cl_psychotherapy_notes unless a valid (non-revoked, non-expired) authorization exists for that export request and covers the note(s). Authorization scope may include date range or specific notes via cl_psychotherapy_authorization_notes.

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Placeholder: Event Contracts

  • No domain events required for MVP. (Future: optional event when psychotherapy note disclosed for audit downstream.)

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Placeholder: API Contracts

  • No new REST APIs. Access via existing CL chart/note hooks and export paths; authorization checked in application logic and RLS.

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Security and Tenant Isolation

  • All tables include organization_id; RLS and app-layer filters enforce org isolation.
  • Psychotherapy note content: encryption at rest; no PHI in logs; all access audited.
  • RLS: SECURITY DEFINER helpers; UPDATE policies include WITH CHECK (§5.2.4); no direct query to RLS-protected tables in policies (§5.7).
  • Export: CL-20/CL-16 MUST check cl_psychotherapy_authorizations (and junction) before including any psychotherapy note in export payload.

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Governance References

  • Cross-Core Matrix: CROSS_CORE_INTEGRATIONS.md — CL-30 is CL-internal; no cross-core row required (all dependencies are PF or within CL).
  • Contract Validation: CONTRACT_VALIDATION_CHECKLIST.md — validate before implementation.
  • Data Dictionary: DATA_DICTIONARY.md — register cl_psychotherapy_notes, cl_psychotherapy_authorizations, cl_psychotherapy_authorization_notes after migration.
  • Encryption at Rest: NFR-1 specifies encryption at rest for psychotherapy note content. Implementation: use Supabase Vault (pgsodium) or application-layer encryption with key management via platform vault. Document chosen approach in implementation log.