Confidentiality in adolescent health care
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- Kelly A Olson, MD, MA
Kelly A Olson, MD, MA
- San Jose Clinic
- Section Editors
- Abigail English, JD
Abigail English, JD
- Section Editor — Adolescent Medicine
- Director and President
- Center for Adolescent Health & the Law
- Diane Blake, MD
Diane Blake, MD
- Section Editor — Adolescent Medicine
- Professor of Pediatrics
- University of Massachusetts Medical School
The concepts of informed consent and confidentiality are complex when the patient is an adolescent. This is particularly true when the needs and wishes of the adolescent conflict with the opinions and preferences of the parents .
The laws governing consent and confidentiality in adolescent health care vary from country to country; within the United States, they vary from state to state. The information in this topic focuses on confidentiality in adolescent health care in the United States.
Clinicians who treat adolescents must be aware of the federal and state laws related to adolescent consent and confidentiality. The circumstances in which adolescents may consent for their own care and the confidentiality laws vary from state to state depending upon the adolescent's status as a minor or adult, the service involved, and the provider's level of concern regarding harm to the patient or others.
The basic laws governing consent for health care are state laws; clinicians who treat adolescents need to be aware of the laws in their state. Confidentiality protections are found in both state and federal law. Clinicians who treat adolescents also must be aware that federal and state funding sources may have specific requirements related to confidentiality for particular services. They should be familiar with the consent and confidentiality policies of the facility in which they practice, and they must be aware of potential ways in which confidentiality can be compromised (eg, record keeping, billing statements, insurance).
This topic will provide an overview of confidentiality in adolescent health care, including definitions, exceptions to confidentiality, and potential threats to confidentiality. Determination of minor status and how it relates to consent for specific medical services, which is closely linked to confidentiality, are discussed separately. (See "Consent in adolescent health care".)
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- Conditional versus unconditional
- Public health perspective
- EXCEPTIONS TO CONFIDENTIALITY
- Child abuse/neglect
- - Consensual sexual activity
- Suicidal ideation or attempt
- Homicidal ideation
- Violent injuries
- Sexually transmitted infections
- Mental health care
- Parental notification
- POTENTIAL THREATS TO CONFIDENTIALITY
- Medical records
- - HIPAA
- - FERPA
- - Electronic records
- - Patient portals
- Payment for services
- - Who is liable?
- - Method of payment
- Ancillary staff
- SUMMARY AND RECOMMENDATIONS