Minor's Records, Coach Request, and Social Media Video
At a high school sports clinic, a 16-year-old volleyball player is brought by her mother for ankle rehabilitation after a grade II lateral ankle sprain. The athlete's coach calls the clinic and asks the PT to send the full medical record, including notes about the athlete's anxiety and a recent episode of self-harm, directly to the coach so the coach can 'decide whether she can play Friday.' The mother says it is fine to send 'whatever the coach needs.' The athlete tells the PT privately that she does not want the coach to know about the self-harm note and asks that her mother not be told either. The PT is also planning a cervical manipulation technique for the first time on this patient and wants to record a video for the clinic's social media. The clinic uses an electronic record system and has a signed general consent to treat at intake.
1. Who can consent to treatment and release of records for this 16-year-old?
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In New Hampshire, a minor generally cannot consent to their own health care except in specific situations; the parent or guardian consents, and the PT should seek the minor's assent. The intake 'consent to treat' is not a blanket authorization to release records. The coach is not a health care provider and has no right to the record. A release to the coach requires a valid, specific authorization, ordinarily signed by the parent or guardian, that identifies the information and the recipient. Even then, release only the minimum necessary, and do not release sensitive mental-health or self-harm information without specific authorization or a legal requirement. If the PT suspects abuse or neglect, mandatory reporting may override.
2. How should the PT handle the athlete's request that her mother and coach not be told about the self-harm note?
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The PT should not promise secrecy. Explain that safety information may need to be shared with the guardian and, if there is imminent risk, with emergency services. Assess suicide and self-harm risk, ask about plan and means, and follow clinic protocol. If risk is immediate, arrange emergency evaluation and notify the guardian. Document the conversation and actions. The athlete's request is important but does not override safety or legal duties. The PT should also avoid disclosing the information to the coach without a valid authorization or legal requirement.
3. May the PT record and post a video of the first-time cervical manipulation?
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No recording or posting without separate informed consent; for a minor, parent or guardian consent plus the athlete's assent. The PT must explain the purpose, risks, benefits, alternatives, and privacy implications of video. The PT must also ensure competence in cervical manipulation and that it is within New Hampshire scope and clinic policy; if this is a first-time technique, obtain training and supervision before using it. Social media use requires HIPAA-compliant authorization and may still be inappropriate. The PT should not post any patient video without written authorization.