An article for physicians by physicians
The physician's role in providing a child's medical information to a parent.
Of interest to all physicians
Physicians frequently receive requests for copies of children's medical records in the midst of conflict, including acrimonious matrimonial or custody proceedings. When a parent asks you to disclose information about his/her child, you must consider whether the parent is entitled to the information.
Custodial parents have full access rights to their children's medical records except where the children have the capacity to make a decision about the collection, use and disclosure of their medical records.
Access parents are entitled to the same information as the custodial parent unless the court orders otherwise.
Generally parents with no right of access are not entitled to medical information.
If in doubt about the access situation, you should request a copy of any custody and access agreement and/or inquire about any court order pertaining to access by that parent. In the midst of a child abuse investigation, you could seek direction from the child welfare authority with respect to a parent's right of access.
With respect to mature minors, privacy legislation in each jurisdiction will govern whether these minors may assume control over the disclosure of their personal health information. Typically, minors who are capable of consenting to treatment will also have the capacity to control their personal health information. These minors should understand what information will be released, and to whom, and should be capable of understanding the consequences of disclosing or refusing to disclose their personal health information.
If the minor is capable of consenting to the disclosure of the information, you should not give the parents any confidential medical information without the patient's consent. You can encourage or support your adolescent patients in discussing problems with their parents depending on the circumstances and if it is in their best interests. In situations where minors are at serious risk of harm because they might harm themselves or for other reasons, you would likely be expected to inform the parents or, in some instances, the child welfare agency.
A child or minor is an individual under the age of majority as defined by provincial/territorial legislation.
Mature minors are minors with the capacity to consent to treatment. The concept of "mature minor" is not applicable in Québec, where the law (the Civil Code and the Act Respecting the Health Services and Social Services, in addition to the applicable privacy legislation) specifically defines the age of consent (14 years old, for most procedures) and the circumstances in which a minor and/or his parents can consent to the release of the minor's medical records.
Where particularly sensitive information is involved, or if you have questions about a child's capacity to control access to his or her own record or about parental rights of access, members can call the CMPA for advice.
You are the physician for two children, ages four and six, who live with their mother and visit their father on weekends and some evenings. The parents communicate poorly, and the father feels his ex-wife has not kept him informed about the children's health and medications. He has requested a copy of their records. The mother would prefer that her ex-husband not be given any information because she believes he will misuse the information in an attempt to obtain custody. The children have had ear infections. Both are allergic to cats. There is a cat in the mother's home.
Question: Is the father entitled to medical information about his children?
Answer: Yes, as an access parent he is entitled to this information. If there is any doubt about the father's access rights, you should ask for a copy of any existing custody and access agreement or court order.
Question: Is the mother's consent required for release of the children's information to the access parent?
Question: On one occasion, the mother discussed her personal health issues with you and these were recorded in the child's chart. Is the access parent entitled to this information?
Answer: No. References in the child's medical record about confidential discussions with the mother concerning her own health, and which are irrelevant to the child's care, should be deleted from the copy provided to the father.
Question: As the physician, must I provide a copy of the record, or alternatively, could I simply discuss the health of the children with the access parent?
Answer: Although the access parent is entitled to this information, you could offer to discuss the children's health if that would satisfy the parent's request.
The bottom line
- When parents ask you to disclose information about their child, you must consider whether the parent is entitled to the information.
- You should be aware of whether the parents are custodial parents, access parents, or parents with no right of access. If in doubt about the access situation, request a copy of any custody and access agreement and/or inquire about any court order pertaining to access.
- Generally, the records of patients who are mature minors should not be released without the minors' consent.
If members have questions about a child's capacity to control access to his or her own record or about parental rights of access, call the CMPA for advice.