Protecting Adolescent Patient Privacy: Four Key Questions
When an adolescent patient requests confidential services, here's what you need to know about their rights and your responsibilities.
Fam Pract Manag. 2019 Jan-Feb;26(1):7-10.
Author disclosure: no relevant financial affiliations disclosed.
HIPAA's confidentiality rules are challenging enough to apply in a typical patient scenario, with an adult patient making his or her own health care decisions. When third parties such as parents of adolescent patients are involved, privacy considerations become even more complex. Physicians must consider not only federal and state laws but also ethical issues.
The AMA Code of Medical Ethics Opinion 2.2.1 discusses the responsibility physicians have to engage minor patients in the decision-making process at a developmentally appropriate level, even if the minor cannot consent to care on his or her own. Opinion 2.2.2 explains the delicate tightrope physicians must walk when an unemancipated minor requests confidential treatment. In these circumstances, physicians are encouraged to educate the patient on situations in which parents or guardians must be notified (e.g., if involving them would be necessary to avert significant harm to the patient or others) and explore the patient's reason for not involving them. Physicians should encourage the patient to talk to a parent or guardian if they are able, and may even offer to facilitate the conversation.
If the adolescent patient still does not want to involve a parent or guardian, the physician should consider the following questions to ensure the patient's privacy is protected, along with parental rights.
When an unemancipated minor requests confidential treatment, balancing the patient's rights with the parent's rights can be complicated.
Some state laws permit unemancipated minors to consent to receive certain types of services on their own, such as reproductive, substance abuse, or mental health services.
Portals can present a privacy challenge if parental access to adolescent records is unlimited.
CAN THE ADOLESCENT CONSENT TO CARE INDEPENDENTLY?
Generally, the parent or legal guardian of a minor must consent to the child's health care service. In these circumstances, the parent “owns” the child's medical record information until the child reaches the age of majority or becomes emancipated. This means medical record information can be shared with the parent or guardian before, during, and after visits. There are some exceptions, however. Emancipated and married minors can consent to their own health care, and their parent or legal guardian does not have the right to any information related to the minor's care without the minor's permission. Additionally, some state laws permit unemancipated minors to consent to receive certain types of services on their own, such as reproductive, substance abuse, or mental health services. The Guttmacher Institute provides a summary of
1. U.S. Department of Health and Human Services. Rights to request privacy protection for protected health information. 45 CFR § 164.522.
2. U.S. Department of Health and Human Services. Other requirements relating to uses and disclosures of protected health information. 45 CFR §164.514(h).
3. Green-Shook S. Parental proxy access via web portals: ensuring compliance and quality documentation. J AHIMA. 2009;80(7):60–61.
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