access to her information and records, they would be entitled to information about most of the general care she has received — minor acute problems, immu- nizations, sports physicals — but whether they could access information about the STD screening and family planning would depend on state or other laws. The laws may prohibit disclosure without the mi- nor’s permission or give the provider dis- cretion over further access of information. If the laws are silent or unclear, the rule gives the provider and other covered enti- ties discretion on whether parents should have access to the medical records. The most challenging issues in a
private practice arise with respect to billing and third-party reimbursement. If the offi ce has routinely sent bills home for the minor’s care, some diligence will be required to ensure that information on the bill does not inadvertently disclose con- fi dential information. The HIPPA rule may minimize these risks if minors request restrictions on disclosure or confi dential
communications. Ultimately, however, ef- fective implementation of confi dential care for minors in a private practice depends on cooperation of the minor, the provider, and any health plan or insurer involved. Experts suggest having the adoles- cent patient, the parents and the pro- vider discuss “ground rules” at a routine healthcare visit. Consider initiating this conversation at your child’s next well visit. You may all agree that normal details will not be shared with you unless your kids are not following the prescribed treatment plan or seem at risk of harming them- selves or others. Some parents will not al- low this degree of privacy. In this situation, it’s imperative that the provider speak to the parent/guardian alone to discuss the importance of confi dentiality and building a rapport with the adolescent.
Cheri Barber, DNP, RN, CRNP, is Past President of NAPNAP and the Coordinator of the PNP Program at UMKC. She is also a PPCP at Pediatric Medical Associates.
A minor’s protected by law
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