Adolescents are concerned about confidentiality and sometimes do not seek health care for this reason.  Myriad federal and state laws affect confidentiality of medical records in general.  However, it is the state that determines the statutes on the rights of minors to consent to healthcare services. Parents must generally consent before medical care is provided to their minor children; however, many states make important exceptions when it comes to sensitive services for which a parental consent requirement might deter an adolescent from obtaining needed care in a timely way. Examples of sensitive services include STI treatment and contraception.  The access to these services helps reduce the transmission of STIs and prevent unplanned pregnancies. In some states, minors themselves may consent for substance abuse treatment, and in about half of the states, they are specifically authorized to consent to outpatient mental healthcare.

Furthermore, minors who may give consent can be divided into to two groups: mature minors and emancipated minors.

• A mature minor is an adolescent younger than the age of majority. Such a minor can consent or refuse to consent to medical treatment if it is established that the minor is sufficiently mature to understand, discern and appreciate the benefits and risks of the proposed medical treatment. The age, ability, experience, education, training, and degree of maturity or judgment of the minor, as well as the conduct and demeanor of the minor at the time of the incident involved, all play a role.
• To contrast, an emancipated minor is one who is legally free of parental control. A court ruling, marriage or enlistment in the U.S military for active duty are the most common scenarios. A minor who becomes a parent becomes the decision maker for the child.

Care of mature and emancipated minors is provided without parental consent or notification, although the physician will frequently work with the adolescent to involve parents in decision making, risk reduction, and ongoing health care. Of note, both mature and emancipated minors must still follow state laws on age-restricted activities such as voting and purchasing alcohol.

Health care providers should therefore be familiar with the regulations in their state of practice as minor consent laws vary between states. Institutions should be well-versed in state law to determine the degree of disclosure to parents/guardians that is permitted and/or required. If state law is not explicit, then institutions or individual providers should establish firm policies regarding the degree of confidentiality.

It is vital (and parents or guardians and adolescents should be informed, both separately and together) that the information each of them shares with the health care provider will be treated as confidential, and of any restrictions to the confidential nature of the relationship. Lastly, electronic health record systems need to be reviewed and possibly customized to accommodate the confidentiality needs related to minor adolescents and comply with the requirements of state and federal laws.

The Guttmacher Institute provides information regarding laws and regulations related to contraceptive, STI, prenatal, adoption and abortion services.

Learn More – Primary References:

ACOG Committee Opinion 803: Adolescent Confidentiality and Electronic Health Records

Guttmacher Institute: An Overview of Minors’ Consent Law

Confidentiality in Pediatric and Adolescent Gynecology: When We Can, When We Can’t, and When We’re Challenged

Adolescent and Caregiver use of a Tethered Personal Health Record System