A 16-Year-Old's Confidential Visit and a Parent's Demand
A 16-year-old girl arrives alone at a family practice clinic and asks for testing for sexually transmitted infections. She says she is sexually active with a 22-year-old partner and asks that her mother not be told. The clinic is in a state where minors 14 and older may consent to STI testing and treatment, and those records are confidential. The same state's mandatory reporting law requires reporting suspected sexual abuse of a minor, including sexual contact between a minor under 17 and a person four or more years older. Two hours later her mother calls, identifies herself, and demands 'the full chart and all test results.' The clinician is with another patient.
1. How should you respond to the mother?
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Do not confirm or deny that the teen is a patient, and do not release results or the chart. Verify the caller's identity and relationship, but relationship alone does not authorize disclosure. Under the stated law, the 16-year-old can consent to STI testing and treatment, and those records are confidential. Tell the mother the clinic cannot discuss any patient information without the patient's written authorization, and offer to have the clinician or office manager call her back. Do not say 'we have no record' if that is false. If the mother raises a safety concern, document it and route it to the clinician.
2. Does the partner's age create a reporting duty, and how should the teen be involved?
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Yes. The disclosed partner age triggers the mandatory reporting law: a 16-year-old is a minor under 17, and a 22-year-old is four or more years older. Notify the clinician immediately and follow the clinic's protocol to the designated state agency. Tell the teen, in plain language and before the report if safe and clinically appropriate, what will be reported and why. Do not promise absolute confidentiality. Do not investigate the relationship or contact the partner. If the teen is in immediate danger, follow emergency procedures. Reporting is a legal duty, not a choice, and does not require parental consent.
3. What should be documented?
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Document objectively: the date and time of the teen's request, her exact statements, the clinician notified and the time, the report made to the agency including the agency name, report number, and person taking it, and the mother's call with what was and was not disclosed. Avoid opinions or speculation. Follow clinic policy for keeping the STI record separate. Note that no results were released to the mother. If unsure, consult the compliance officer before charting.