During the Appointment

Seeing a Clinician

How should clinicians set expectations with adolescent patients and their family members about confidentiality and private time?

Answer	Clinicians should explain—up front and clearly—that private time with adolescent patients is routine and developmentally appropriate. During this conversation, outline the clinic’s confidentiality policy and its limits. Confirm both the adolescent and family understand, and obtain parental guardian consent before one-on-one time with the adolescent patient.
What to do	Normalize private time at the start of each visit. Describe what will remain confidential and what may need to be disclosed. Document that the confidentiality policy was explained and that both the patient and parent/guardian agreed to the private portion of the visit.
Sample script	“Part of every teen visit includes a few minutes alone with the adolescent. This private time helps them ask questions, build trust, and practice autonomy. Most information stays confidential unless there is a safety concern. Parents or guardians are invited to step out for this portion and will have a chance to discuss follow-up afterward.”

Are clinicians leaving time for one-on-one conversations with adolescent patients?

Answer	Private time is recommended to discuss sensitive topics such as sexual health, mental health, substance use, safety, and identity.
What to do	Ensure every adolescent visit includes a routine, one-on-one conversation. Even 5–10 minutes is meaningful.

Are clinicians prepared to explain what information that must be reported to authorities?

Answer	Young people may divulge information that must be reported to child protection or law enforcement authorities. Young people have the right to know what type of information must be reported before choosing to divulge.
What to do	Ensure clinicians understand mandatory reporting laws and can explain them to young people. Clearly explain limitations and requirements to young people during confidentiality discussions. Create a written policy to give to young people so they can read the information.
Resources	Age for consent in Washington: RAINN \| Rape, Abuse and Incest National Network Mandatory reporting in Washington: Mandatory Reporting of Child Abuse and Neglect \| Washington State Department of Children, Youth, and Families

What services can an adolescent consent to independently, and can those services be kept confidential?

Answer	Services vary by state law. In Washington state, they include: At any age: Emergency medical care, birth control, abortion, prenatal care Age 14 or older: Sexually transmitted disease testing and treatment Age 13 or older: Outpatient mental health treatment, outpatient substance use disorder treatment. Other situations: Teens under 18 may also access care services without a parent or guardian’s consent if: Tey are married to an adult They are legally emancipated from their guardian(s) Determined to be a mature minor by a health care provider They are an unaccompanied homeless youth age 13 or older
Considerations	In general, services minors can consent should be confidential; but, billing statements for visits and diagnostics, insurance explanations of benefits (EOBs), or portal notifications may inadvertently reveal care. Clinicians should be aware of these limitations and discuss them with their adolescent patients.
What to do	Review which parts of the visit are confidential, and discuss any potential disclosure via insurance or portal systems. Help the adolescent complete any confidentiality paperwork for insurance payers, like this form (link to OIC form).
Sample script	“For some services, like sexual health or counseling, you can consent for yourself and keep the visit private. I’ll also explain what information might still appear in the portal or on insurance statements.”

Documentation

Does the institution have an option for confidential notes?

Answer	Some EHRs have built in confidential note types or use restricted-access fields specifically for sensitive adolescent health information (e.g., sexual or reproductive health, mental health, substance use).
What to do	Know which confidential note types your institution supports and use them consistently for sensitive information. Use confidential or restricted notes for all information related to services minors can consent to independently. Document that the parent or guardian received and understood with the clinic’s confidentiality policy and that they agreed to the private one-on-one time portion of the visit.

Answer

Some EHRs have built in confidential note types or use restricted-access fields specifically for sensitive adolescent health information (e.g., sexual or reproductive health, mental health, substance use).

What to do

Know which confidential note types your institution supports and use them consistently for sensitive information.
Use confidential or restricted notes for all information related to services minors can consent to independently.
Document that the parent or guardian received and understood with the clinic’s confidentiality policy and that they agreed to the private one-on-one time portion of the visit.

If the note is not confidential, does the clinician know with whom it is shared (patient portal or records request)?

Answer	Non-confidential notes are often visible to the adolescent’s proxy (parent/guardian) portal accounts, caregivers, and may also be included in records requests.
What to do	Clinicians should review their institution’s EHR policies regarding note visibility. Always inform adolescent patients of any confidentiality limitations.

If the health care organization participates in a health information exchange (HIE), is there a way to prevent release of confidential information or at least mark it as confidential?

Answer	Some HIEs allow clinicians to flag certain visits or data as restricted or confidential. However, not all systems have this function available.
What to do	Check local HIE policies and use restricted or sensitive visit flags when available. Document all confidential information in the chart to guide future release requests. Offer information to teens and families on how to opt out of HIE sharing, if they would like.

Do clinicians know what health information is released to adolescent patient portals and what is released to proxy accounts?

Answer	Information shown in adolescent (patient) portal and in proxy (guardian) accounts is often different. The information released to portal accounts may also vary by institution.
What to do	Stay familiar with your institution’s portal access policies for adolescent and proxy accounts. Know which notes, labs, medications, and visit summaries are visible in each account type. Review portal access policies regularly and discuss potential disclosures with adolescent patients.
Sample script	“Some of the information from today’s visit may appear in your patient portal. I’ll explain what you’ll see and what might also be visible to your parent or guardian, so you understand what stays private.”

Prescriptions – Clinician

Can clinicians label medications as confidential or private in the EHR?

Answer	Some EHRs allow certain medications (e.g., contraception, mental health, or substance use treatment) to be flagged as confidential, restricting their visibility from proxy portal accounts. Not all EHRs have this functionality.
What to do	Know your institution’s policies and EHR tools for labeling sensitive medications. If confidential labeling is not available, consider alternative workflows (e.g., paper prescriptions handled discreetly).

Are medications shared with the patient portal, proxy accounts, or both?

Answer	In many institutions, active prescriptions may appear in both the adolescent’s patient portal and proxy accounts. This can inadvertently disclose sensitive medications.
What to do	Review which information is visible in each account type and counsel adolescents about potential exposure through portals.

If the medication is sent electronically to a pharmacy, will an alert be sent to a guardian when the medication is ready for pick up?

Answer	Many electronic pharmacy systems send notifications to the guarantor or guardian if their contact information is linked to the patient’s account.
What to do	Check with pharmacy staff about confidentiality options for adolescent prescriptions. Discuss potential disclosure through pharmacy notifications with adolescent patients. Consider offering a written prescription for in-person visits, so the teen can take them to the pharmacy instead of sending the prescription electronically. Ask the patient to discuss privacy options with the pharmacist when picking up their medication.
Sample script	“Some pharmacies automatically notify parents when a prescription is ready. We can talk about ways to pick up your medication privately or confirm your pharmacy’s policies.”