Read the Agreements

Last updated: October 27, 2026

Why this page exists. Putting protected health information through any software is a consequential decision, and the people who make it should be able to read the primary documents rather than a summary we wrote. Keisen's own agreement with your practice is published in full. Anthropic marks its agreement with Keisen confidential, so we explain that one instead of posting it, and say where you can read the full text yourself. If something here is unclear, ask; we would rather answer than be paraphrased.

1. The data-flow chain in Healthcare mode

This is where protected health information goes when a practice uses the API key Keisen provisions for it, and which agreement covers each party. PHI makes one trip: from the clinician's computer directly to Anthropic. It does not pass through Keisen.

Your practice (covered entity). Dictation, chart screenshots and pasted text are captured on the clinician's computer. Audio is transcribed there by Whisper and never leaves the machine. What leaves is text, images and attached files, only when the clinician sends a message or asks for a note, sent over HTTPS straight to Anthropic's first-party API (api.anthropic.com). No relay, proxy or other server sits in between.
Your own policies and your own Notice of Privacy Practices
Keisen L.L.C. (your business associate). Keisen licenses the software and provisions and administers your practice's API key: a key in a workspace of Keisen's own Anthropic organization that is reserved for your practice, with its own spending limit, and that Keisen can revoke. The key is entered under Settings → API Key on your practice's computers, and KeisenVPA saves it in its own preferences on each computer, not in the system keychain. Keisen runs no server in the path of your content; this version does not send it to Keisen, and Keisen does not store it.
Keisen BAA with your practice: template, draft under legal review; Keisen is not yet provisioning practices under a BAA
Anthropic, PBC (Keisen's subcontractor). Anthropic's first-party API generates the draft and returns it. Each request arrives under your practice's key on Keisen's organization, which runs Anthropic's HIPAA configuration under Keisen L.L.C.'s own Business Associate Agreement with Anthropic. That agreement covers the API features Anthropic lists, and not features in beta; KeisenVPA sends no beta feature in Healthcare mode. Whether the agreement covers the other features KeisenVPA's requests use is not yet confirmed by Anthropic (section 3). That organization does not use zero data retention: prompts and outputs are retained for a limited period under Anthropic's terms, and they are not used to train models (section 3).
Anthropic BAA with Keisen L.L.C.: executed 2026-08-15

This is also Keisen's current list of subcontractors that handle PHI: Anthropic, PBC, and no one else. Keisen's license server and the app's opt-in usage statistics run on Cloudflare and never receive clinical content; see the Privacy Policy.

What KeisenVPA keeps on the computer, in any mode:

Audio recordings — Whisper transcribes on the computer; no audio is sent to anyone.
Saved notes and transcripts — saved as files in folders on the computer (notes by default in a patients folder in Documents, changeable under Settings → Folders). KeisenVPA never uploads the files, but a cloud-sync service that covers the folder, such as iCloud's Desktop & Documents option, uploads them; the app warns when the notes folder is synced.
Attachment copies and automatic capture snapshots — the moment you attach a screenshot, PDF or other file, KeisenVPA copies it into its own folder on the computer (on a Mac, ~/Library/Application Support/KeisenVPA/captures; on Linux, ~/.config/KeisenVPA/captures), whether or not anything is ever sent. Those copies are deleted when the tab is closed or the app quits; tabs kept for the next launch (tab restoring turned on, or Save & Quit chosen when quitting) keep theirs until you close them or a later quit does not keep them, and after a crash they stay until the app next quits. KeisenVPA also writes a snapshot of the conversation's captures there each time you send (before the request is made, so it exists even if nothing reaches Anthropic), when a request fails, when you clear sent attachments, when you close a tab and when the app quits, including for conversations never sent but not for tabs kept for the next launch, whose copies remain: every attached screenshot, PDF or other file, each pasted text, the transcript and the conversation. They contain PHI. The twenty most recent snapshots are kept and older ones deleted; captures you export by hand stay until you delete them. iCloud does not sync this folder; other backup tools, such as Time Machine, may copy it.
The scratchpad — what you type in the floating scratchpad is saved to ~/keisenvpa/scratchpad.txt in your home folder, which iCloud does not sync and other backup tools may copy.
Live Translation session files, the vocabulary file and, only when the window's Save audio switch is on (it is off by default), each session's audio as a FLAC file — saved in KeisenVPA's own folder on the computer (on a Mac, Application Support; on Linux, ~/.local/share/KeisenVPA) and nowhere else; Keisen never receives them, and the audio is sent to no one. Their text is sent to Anthropic for translation, word links and grammar labels; Work offline holds it back, and words added offline are sent for grammar labels once you are back online (Privacy Policy, section 3.3). Live Translation can be opened from Healthcare mode too, under the same key, and is not for PHI in any mode.

With your practice's own Anthropic key instead, Keisen's agreement with Anthropic does not apply: requests go from your computer to Anthropic under your practice's own Anthropic account, and what covers them is your practice's own agreement with Anthropic and that account's configuration. Professional access on a personal key includes no BAA and is not intended for PHI.

2. The agreements

Keisen Business Associate Agreement draft — under legal review

The template a practice signs with Keisen L.L.C. It sets out what Keisen may do with PHI on your behalf, the safeguards it keeps (a separate key and workspace for each practice, a spending limit, revocation), its subcontractor (Anthropic), breach notification, the conditions of use that Anthropic requires Keisen to pass on to you, and what happens when the agreement ends. Until legal review is complete, read it as a draft: the terms may change before a practice signs, and the published template is not an offer to contract.

Read the template
PDF (coming)

Keisen L.L.C.'s Business Associate Agreement with Anthropic executed 2026-08-15

The agreement under which Anthropic handles the PHI that reaches it under a key Keisen provisions. Keisen L.L.C. executed it on August 15, 2026, for its own Anthropic organization, and KeisenVPA's Healthcare mode relies on this agreement and no other. Anthropic marks the document confidential, so it is not posted here: section 3 explains what it covers and the conditions that reach your practice, and says where you can read the full text.

3. Keisen's agreement with Anthropic, explained

Every page of Anthropic's agreement is marked confidential, and Anthropic's Commercial Terms limit sharing information marked that way. So instead of posting it, we explain it here in our own words, using what Anthropic states publicly wherever we can. Where this page and Anthropic's documents differ, Anthropic's documents govern.

Who signed it, and when

Keisen L.L.C., on August 15, 2026, by enabling HIPAA compliance in the settings of its own Anthropic organization, which executes Anthropic's Business Associate Addendum for that organization. Under it, Anthropic is Keisen's subcontractor; under the Keisen template, Keisen is your practice's business associate.

What it covers

Anthropic's first-party API, used from an organization with Anthropic's HIPAA configuration enabled, and only the API features Anthropic lists. Keisen's organization runs that configuration, and every key Keisen provisions belongs to it. For the Messages API, which KeisenVPA uses, Anthropic's public summary lists the covered features (prompt caching, structured outputs, memory, web search, and the bash and text editor tools) and states that features it does not list are not covered.
A beta feature, never used in Healthcare mode. Anthropic's summary also says that features in beta are not covered. KeisenVPA can turn on one beta feature, which re-runs a request on a fallback model when Anthropic's safeguards decline it. Of the models in KeisenVPA's Settings, only Claude Opus 5 and Claude Sonnet 5 use it; Claude Fable 5, Claude Mythos 5 or a later Opus 5 or Sonnet 5 model would use it too if named in the ANTHROPIC_MODEL environment variable, which overrides Settings. KeisenVPA never does so in Healthcare mode, whatever the model, nor on a tab in another mode that KeisenVPA has marked as holding patient information (the tab then says Healthcare rules apply), nor for batch notes. There, a request Anthropic's safeguards decline shows the refusal instead of being re-run on another model. On a tab that is not marked, in General, Legal or Linguist mode, those models still use it, so use Healthcare mode for requests that contain PHI. Earlier versions of KeisenVPA used the beta with those models on every request: on an earlier version, keep Claude Opus 4.8, the default model, selected for requests that contain PHI.
An open question about KeisenVPA's requests. KeisenVPA's requests also use features that Anthropic's list does not name and that it does not describe as beta: image and PDF attachments, extended thinking (with, at its highest setting, the effort parameter that goes with it), and streamed responses. Anthropic's documents do not say whether these count as covered features, and Anthropic has not confirmed to Keisen that they do. Until it does, we do not describe every request KeisenVPA sends as covered by Anthropic's agreement.
Only Keisen's organization. It does not cover claude.ai, or a key your practice obtains from Anthropic on its own.
What Anthropic owes Keisen. To use and disclose PHI only as the agreement permits (to provide the service, and for Anthropic's own management, administration and legal duties), to safeguard it, to bind its own subcontractors to the same restrictions, to report a breach to Keisen within ten business days of discovering it, and, after Keisen's agreement with Anthropic ends, to return or destroy PHI where Anthropic finds that feasible. The Keisen template carries these commitments on to your practice (section 6). When only your practice's agreement with Keisen ends, Anthropic keeps what it already holds on its ordinary retention schedule, with no duty to return it, and its terms still allow the uses described under Retention and training below until it deletes it; Keisen cannot narrow those uses for a practice that has left (section 8.5).

Retention and training

Keisen's organization does not use zero data retention; it runs Anthropic's HIPAA configuration instead. Prompts and outputs are retained for a limited period under Anthropic's terms: Anthropic's Privacy Center states that it deletes API inputs and outputs from its backend within 30 days of receipt or generation, unless they must be kept longer, for example to enforce its Usage Policy or to comply with the law (How long do you store my organization's data?). Where Anthropic's trust and safety systems flag content under its Usage Policy, the same page says Anthropic keeps the inputs and outputs for up to two years and the classification scores for up to seven; Anthropic does not tell Keisen which requests, if any, were flagged. Anthropic may use limited content for trust and safety, for support, and to improve or tailor the service for Keisen's organization — which holds every practice's workspace, so that tailoring is not for your practice alone. Your PHI is not used to train Anthropic's models, and Anthropic's Commercial Terms say the same of all customer content.

Conditions that reach your practice

Anthropic's agreement makes its HIPAA Implementation Guide binding, and information sent in a way the Guide does not allow falls outside the agreement's protection. These conditions from the Guide therefore apply to your practice too, and the Keisen template repeats them as terms (Exhibit A, Part 3):

Charting is permitted, with conditions. Documentation work such as charting, billing and coding is a permitted use, provided your practice tests the output for accuracy in its own use, confirms that the use complies with the law, and lets only trained people who hold the licenses or qualifications the work requires use it.
Not for patient interaction, diagnosis or treatment. Do not use it in direct interactions between a provider and a patient, to diagnose a patient, or for treatment purposes.
No PHI outside the note request. Never put PHI in a support request to Keisen or to Anthropic, in a screenshot attached to one, or in a profile, workspace, organization or billing field.
Some Anthropic features are expressly outside coverage. The Batch API, Files API, Skills API, Code Execution, Computer Use and Web Fetch are not covered. KeisenVPA uses none of them, and the key Keisen provisions is for KeisenVPA only.

Read the full text yourself

Anyone with an Anthropic Console organization can read Anthropic's full Business Associate Agreement and its HIPAA Implementation Guide under Organization settings → HIPAA compliance, before enabling it. Anthropic's help article still describes arranging the API agreement through an Anthropic contact; the Console panel described here is where Keisen read both documents and enabled HIPAA compliance on August 15, 2026. Anthropic's public summary of BAA coverage and its Commercial Terms are open to everyone.

4. What you are responsible for

A Business Associate Agreement covers the business associate. The covered entity — your practice — keeps these:

Minimum necessary. Dictate and capture what the note needs, not the whole chart. Screenshots carry everything on the screen.
Your own Notice of Privacy Practices and your own HIPAA policies, training and approvals. Using KeisenVPA does not replace them.
The key you use. Either the key Keisen provisions for your practice (the chain above, under Keisen L.L.C.'s executed agreement with Anthropic), or your own Anthropic key under your practice's own BAA with Anthropic and your own organization's configuration. A personal key without a BAA is not for PHI.
Keeping the key private. KeisenVPA saves the key in its preferences on each computer it is entered on. Use it only in KeisenVPA, do not share it outside your practice, and tell Keisen at once if it may have been exposed, so that Keisen can revoke it and issue another.
Anthropic's conditions of use. Accuracy testing, qualified users only, and no use in direct patient interaction, to diagnose, or for treatment purposes (section 3). Use Healthcare mode for requests that contain PHI, and on an earlier version of KeisenVPA keep Claude Opus 4.8 selected for them (why); do not use Live Translation with PHI.
No claude.ai with PHI. Keisen's agreement with Anthropic covers the API organization your practice's key belongs to. Pasting patient information into claude.ai, the web or mobile product, is outside every agreement on this page.
Reading and signing every note. KeisenVPA drafts; the clinician reviews, corrects and signs. Nothing is written to a chart automatically.
The device. Full-disk encryption, a strong login, a screen lock, a notes folder that no cloud-sync service copies off the computer, and sensible retention for the notes stored on it. See HIPAA and KeisenVPA.

Not legal advice. This page describes KeisenVPA's data flow, publishes Keisen's agreement and explains Anthropic's. Whether your workflow meets HIPAA for your practice is a question for your compliance officer or counsel. Questions about the chain itself: keisenvpa@proton.me.