Records Request After Divorce
A 16-year-old patient received anterior crowns after a bicycle trauma. The mother consented to treatment and attended all visits. The parents are divorced. The father has joint legal custody but does not live in the home. The account has an unpaid balance of $480. The father sends a written request for the complete dental record, including the patient's statement during the history that she occasionally uses cannabis. The office manager says the practice will not release records until the balance is paid and will redact the cannabis note because 'the father does not need to know that.' The patient tells the dentist she does not want her father to see the cannabis note. The dentist must decide what to release.
1. Can the practice withhold the records solely because of the unpaid balance? Analyze under Georgia record-access principles.
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Issue: Whether a dental practice may condition release of records on payment of an outstanding balance.
Reasoning: Georgia law and Board expectations generally give patients a right to a copy of their dental records. A reasonable copying fee may be charged, but the records themselves are the patient's clinical information, not collateral for a debt. Withholding records solely to collect an unpaid balance can interfere with continuity of care and may constitute unprofessional conduct.
Application: The $480 balance does not justify refusing the father's request. The practice may charge a reasonable fee for copying, but it should release the records once the fee is paid or handled under office policy. The practice should not use the records as leverage.
Conclusion: Release the records; do not withhold solely for nonpayment. Document the request, the fee, and what was released.
2. How should the dentist handle the father's custody status and the 16-year-old's confidentiality request?
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Custody: The dentist should ask for the custody order or other documentation. If the father has joint legal custody, he generally has the right to access the minor's dental records unless a court order limits that right. If the mother has sole legal custody, the father may not be entitled to access. The practice should not guess from the parents' living arrangements.
Confidentiality: A 16-year-old is still a minor in Georgia. The dentist should respect the patient's concerns but cannot promise absolute confidentiality if a legal custodian has access rights. The dentist can discuss with the patient what will be released and why, and can redact information that is not part of the dental record or that would create a safety risk. The cannabis note, however, is part of the clinical history and may be relevant to treatment.
Conclusion: Verify custody first. If the father is a legal custodian, release the record with a reasonable copying fee, but discuss the cannabis note with the patient and document the decision. Do not redact clinical information solely to avoid parental discomfort.
3. What should be documented about the request and release?
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Document the date and manner of the request, the identity of the requester, the custody documents reviewed, the patient's stated preference, the dentist's reasoning, the copying fee, and an inventory of what was released or withheld. If anything is withheld, state the legal or clinical basis. Keep a copy of the written request and any authorization. This record protects the practice if a parent later disputes the release and shows that the dentist balanced access rights with the patient's confidentiality concerns.