Confidentiality and Consent in the Care of the Adolescent Patient.

Abstract

1. Sofya Maslyanskaya, MD* 2. Elizabeth M. Alderman, MD* 1. *Division of Adolescent Medicine, Children's Hospital at Montefiore, and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY * Abbreviations: CDC: : Centers for Disease Control and Prevention EHR: : electronic health record EOB: : explanation of benefits HIPAA: : Health Insurance Portability and Privacy Act HIV: : human immunodeficiency virus SAHM: : Society for Adolescent Health and Medicine STD: : sexually transmitted disease Confidentiality protections are critical in the provision of comprehensive primary care of adolescent patients. The protections differ based on state laws and are limited by electronic health record documentation and billing operations of individual physician practices. Physicians need to strive to increase their knowledge regarding confidentiality protections for their adolescent patients. Moreover, physicians should understand their role in preventing possible confidentiality breaches. After completing this article, readers should be able to: 1. Define confidentiality, its limitations, and reasons for developmentally appropriate confidentiality protections for adolescents. 2. Recognize confidentiality protections for adolescents provided by state and federal laws, including the Health Insurance Portability and Privacy Act privacy rule. 3. Explain minor consent laws. 4. Describe the limitations and advantages of the electronic health record in providing confidentiality protections. 5. Identify concerns and solutions related to billing for confidential services. A 16-year-old girl who has been your patient since birth presents to an appointment alone and requests testing for sexually transmitted diseases (STDs). She also does not want her parents to find out about this visit. How would you proceed? ### Confidentiality and Autonomy The provision of confidentiality and the ability of adolescents to consent for certain health concerns are the cornerstone of optimal adolescent health-care. (1) According to this tenet, information about an adolescent’s health-care is not disclosed without his or her permission. Assurance of confidentiality is important to protect the adolescent’s health and to safeguard public health. The major causes of morbidity and mortality in adolescents are due to risky behaviors such as sexual activity and alcohol and substance use, as well as unmet mental health needs. During the past 3 decades, research has supported the importance of the …