This study explored the impact of law and policy on syndromic disease surveillance (SyS) practice. We conducted semi-structured, in-depth interviews with 55 SyS stakeholders from six jurisdictions and facilitated focus groups with SyS stakeholder organizations. Four main findings emerged. First, SyS was largely conducted under the same legal authority as "traditional" public health surveillance. Second, requirements for "Meaningful Use" have eased health care facilities' SyS-related legal concerns. Third, very few legal concerns were expressed related to BioSense. Finally, primary barriers to maximizing the potential of SyS systems were technical issues and limited health department resources, not legal concerns.