Before the Appointment

Scheduling

Can adolescents schedule their own appointments?

Answer	Washington state laws allow minors to consent to certain types of services including reproductive health, mental health, and substance use. This means they can schedule appointments for these services.
Considerations	Many health systems require a parent or guardian to be listed as the “guarantor” (person responsible for bills) in the electronic health record (EHR). Some systems only let the guarantor’s account schedule appointments, which can limit adolescents from self-scheduling online or by phone.
What to do	Create procedures that let youth schedule their own appointments with confidentiality options. Train scheduling staff about state minor-consent laws and institutional workflows for confidential scheduling.
Sample script	“Some teens can make their own appointments depending on the reason for the visit. I’ll help make sure your appointment is scheduled in a way that protects your privacy.”

How can confidentiality be noted in the chart?

Answer	Some EHRs allow confidential flags or to make restricted or confidential notes. If you can’t flag a visit, use a generic visit reason (e.g., “office visit”) instead of a specific one (like “contraception”).
What to do	Work with your health information management and compliance teams to establish workflows for confidential visits. Avoid visit labels that may compromise confidentiality (e.g., “pregnancy test”) that could reveal private information in public parts of the record.

Who gets appointment reminders?

Answer	By default, reminders often go to the guarantor’s contact information, which may breach an adolescent patient’s confidentiality.
What to do	Ask adolescents for a safe number or email just for reminders. If possible, document it as their confidential contact. Configure the scheduling system to use this contact for appointment reminders, or don’t send reminders them if an appointment is flagged confidential.
Sample script	“Our system sometimes sends reminders to parents by default. Do you have a private number or email we can use for reminders instead?”

How are urgent or same-day visits handled for adolescents seeking confidential services?

Answer	Most urgent, same-day or walk-in visits workflows may automatically notify parents or guardians. Staff should flag confidential visits and coordinate discreet scheduling when possible.
What to do	Set up clear steps for handling urgent or walk-in visits that preserve confidentiality. Make sure all staff know and can identify and process confidential appointments appropriately.

Can adolescents use telehealth on their own? How do we keep these visits confidential?

Answer	Many telehealth systems require a guardian’s emails or login for access. Staff should verify private access settings.
What to do	Train staff on telehealth workflows for minors. Ensure that the adolescent’s private access is set-up before the visit.

Does my clinic or practice have a written policy on adolescent confidentiality to share with patients and families?

Answer	A written confidentiality policy helps set clear expectations for staff, adolescents, and families. The policy should outline which services are confidential, when confidentiality might be limited (e.g., safety concerns), and how information is shared or protected. Sharing this information as a written document can help normalize confidentiality practices and reduce misunderstandings.
What to do	Develop and maintain a documented policy on adolescent confidentiality, reviewed and approved by institutional leadership. Share the policy during registration or send to patients and families before telehealth appointments. You can also reference it during clinical encounters.
Sample script	“Our clinic has a confidentiality policy that explains what information stays private and when we may need to share something for safety reasons. You’ll get a copy today so you and your family know what to expect.”

Check-In / Registration

If check-in forms ask for private health information, is there a way to keep that confidential in the EHR?

Answer	Some EHRs allow sensitive information to be stored in confidential fields; others do not. If this isn’t possible in the EHR, avoid scanning sensitive paper forms directly into the general chart. Instead, route them to the clinician for secure documentation.
What to do	Use adolescent-friendly tools (e.g., CRAFFT, PHQ-A) that can be linked to restricted-access or confidential EHR fields whenever possible.

Do adolescents have private space to fill out forms?

Answer	Confidentiality may be compromised if forms are completed in front of caregivers.
What to do	Give adolescents a private area to complete forms during the rooming process, for example, in the exam room after separation from caregiver.

How is confidentiality explained and assured on forms?

Answer	Adolescents should understand how their information will be used and who will see it.
What to do	Add a short confidentiality statement on intake forms. For example: “Your answers will be shared only with your health care team. They will not be shared with your parent or guardian unless you give permission or if there is a safety concern.” Make your clinic’s adolescent confidentiality policy easy to find on your website and post it in waiting areas.

Are registration staff collecting and documenting adolescent contact information correctly?

Answer	Teens should be offered the chance to give their own email or phone number.
What to do	Ask teen patients for their personal email or phone contact information. Record this in the medical record patient contact information section and not the guarantor’s information. Mark this contact information confidential, when possible.

Are patient portal accounts set up correctly for adolescents and proxies (parent/guardian/caregiver)? Are young people given the opportunity to decide who has access?

Answer	Access rules for patient and proxy accounts differ across institutions. Staff must know what data each account type reveals.
Considerations	Guardian email addresses may be incorrectly linked to the patient’s portal account, giving guardians unintended full access. Adolescents may share their login credentials with caregivers, which might give them access to all portal content despite account set up.
What to do	Make sure teen and proxy accounts are registered separately and accurately. Explain clearly to both teens and caregivers why these separate accounts matter and how access differs. Create a clinic-wide policy and process for educating families about the importance of this distinction, the nuances of what is shared in each, and the confidentiality risks of account sharing. Normalize the explanation by framing it as a routine practice for this age group. Encourage more transparency within your institution and at EHR vendor levels. Talk about the importance of adolescent-friendly portal accounts, ideally letting adolescents understand and agree to who has access to their health information and what exact information is shared across their proxy accounts.
Sample script	“As teens get older, they begin to have some private communication with their health care team. That’s why we set up separate accounts — it gives teens space to ask questions while also keeping parents connected to important parts of their care. You’ll still see key information of their health record through your proxy account.”

What paperwork is needed for an adolescent to be seen without a guardian?

Answer	This depends on your institution and state law. Usually, one of two things is required: State minor consent laws that allow independent care (e.g., for sexual health, mental health, or substance use). For general care, a parent or guardian must sign a “Consent to Treat a Minor” form signed before the visit.
What to do	Registration staff should know your institution’s requirements and check that all permissions are on file at or before the visit.

Rooming

Are adolescents roomed independently or are guardians involved in the rooming process?

Answer	Adolescents should be offered the choice to be roomed alone or with a person they trust (parent, guardian, friend, trusted adult). Some institutions require caregivers first.
What to do	Normalize independence by offering one-on-one time at vitals or screening. Use consistent language to explain the process.
Sample script	“We like to give teens space to answer a few questions privately. Would you like to come back on your own for this part?”

Who takes vital signs and how is it kept confidential?

Answer	Questions about weight, LMP, or symptoms that might be sensitive should be asked privately.
What to do	Train staff to take vital signs and ask personal questions during one-on-one time.

How do staff handle questions about sexual orientation and gender identity (SOGI) or other sensitive health information?

Answer	Asking about SOGI, other sensitive information, or medications in front of caregivers can compromise confidentiality.
What to do	Establish a policy and procedure to avoid asking sensitive questions in the presence of a guardian. Train all relevant staff, including MAs and nursing. Defer sensitive questions until the adolescent is alone. Document SOGI and other sensitive data in EHR-integrated restricted-access or confidential fields, when available.

How are urgent or same-day visits handled for adolescents seeking confidential services?

Answer	Most urgent, same-day or walk-in visits workflows may automatically notify parents or guardians. Staff should flag confidential visits and coordinate discreet scheduling when possible.
What to do	Set up clear steps for handling urgent or walk-in visits that preserve confidentiality. Make sure all staff know and can identify and process confidential appointments appropriately.

Can adolescents use telehealth on their own? How do we keep these visits confidential?

Answer	Many telehealth systems require a guardian’s emails or login for access. Staff should verify private access settings.
What to do	Train staff on telehealth workflows for minors. Ensure that the adolescent’s private access is set-up before the visit.

Does my clinic or practice have a written policy on adolescent confidentiality to share with patients and families?

Answer	A written confidentiality policy helps set clear expectations for staff, adolescents, and families. The policy should outline which services are confidential, when confidentiality might be limited (e.g., safety concerns), and how information is shared or protected. Sharing this information as a written document can help normalize confidentiality practices and reduce misunderstandings.
What to do	Develop and maintain a documented policy on adolescent confidentiality, reviewed and approved by institutional leadership. Share the policy during registration or send to patients and families before telehealth appointments. You can also reference it during clinical encounters.
Sample script	“Our clinic has a confidentiality policy that explains what information stays private and when we may need to share something for safety reasons. You’ll get a copy today so you and your family know what to expect.”