The HIPAA Privacy Rule and Military Health Care: What Parents of Minors Need To Know

FALLS CHURCH, Va. – Are you the parent or legal sponsor of a minor child? If so, there are things you should know about what access you have to your child’s health care records and choices. The Health Insurance Portability and Accountability Act Privacy Final Rule protects minors’ privacy concerning their health care choices and treatment. To protect your child’s health records, this rule limits your access to your child’s protected health information (PHI).

“The HIPAA Privacy Rule gives clear guidance to ensure Americans’ private health information is protected,” said Dr. Anmarie Widener, chief of the Defense Health Agency’s Privacy and Civil Liberties Office. “The HIPAA Privacy Rule extends this protection to minors. It’s important for parents and legal sponsors to understand what they can and can’t access about their child’s own health care information.”

The Defense Health Agency (DHA) complies with HIPAA privacy rule policies on how parents and legal sponsors access their minors’ PHI. These policies apply stateside. The privacy rule defines minors as people who are:
• Under the care, custody, and support of their parents or legal sponsor until the child is 18
• Students under 21 years old who are still under the care, custody, or support of their parents or legal sponsor
• Under 18 years old who aren’t or haven’t been married
• Not a member of the U.S. uniformed services
• Under 18 years old and not self-supporting or living separately from their parents or legal sponsor

Overseas, a minor can request reproductive health services. This includes telehealth services received from a provider located at a military hospital or clinic. If their health care provider determines that the child is mature enough, the child can get care without parent or legal guardian consent.

Key points for stateside PHI access
Stateside, all Americans have access to both electronic and print health records.

So, what are the limitations for accessing your child’s PHI?

Within the military’s health system, you can access your and your family’s electronic health records (EHRs) using MHS GENESIS. MHS GENESIS offers each beneficiary a secure patient portal. This portal lets you view health records and prescriptions. You can also use it to make and track appointments, send messages to your provider, and more.

According to the Parental Access to Protected Health Information of Unemancipated Minors Memorandum, access to EHRs is as follows:
• Minors ages 12 and under: Parents and legal sponsors can access EHRs and all online PHI.
• Minors ages 13-17: Parents and legal sponsors have access to their children’s online patient portal to view appointments, messaging, immunizations, and allergy care only.

You can also access paper health records under certain circumstances:

Minors ages 17 and under: Parents and legal sponsors may still get health records for their children. To get paper records, you must go through the hospital or clinic’s medical records department.

Keep in mind, you can only get both paper and electronic records when your child:
• Didn’t give their own consent for the visit, or
• Consented to the care and gave their permission in writing to allow you access to their PHI for that visit only.

Informed consent is when a patient is competent to make a voluntary decision about whether to undergo a procedure of intervention. Minors can give informed consent for certain types of care. This includes mental health, pregnancy, and sexually transmitted disease care. In these cases, state and federal HIPAA laws protect their privacy. Each of the 50 states, U.S. territories, and the District of Columbia have their own rules for when a minor can consent to the care they get. The DHA observes those state-by-state rules under all circumstances. Check your state’s laws for details.

Key points for overseas PHI access
Things are different overseas with accessing PHI related to your child’s reproductive health care services. The DHA can’t mandate state or federal law overseas. Because of this, military hospitals and clinics must follow guidance provided by the Minors and Reproductive Health Care Services (Overseas) Memorandum. This guidance helps military providers overseas decide if a minor is mature enough to make their own reproductive health care decisions.

As defined in this memo:
• A “minor” is a patient 18 or younger.
• A “mature minor” is a patient 15 or older.

Some countries may interpret these terms differently. Check with the TRICARE Overseas contractor to learn more.

The minor’s informed consent to receive care at a military hospital or clinic overseas determines parental access to PHI overseas. If the minor gives consent for a healthcare visit, you can’t access to the child’s health records for that visit unless the child has consented to provide you that access.

As defined by the memo, reproductive care may include:
• Prescription drugs and treatment to prevent pregnancy.
• Exams to diagnose and treat reproductive health conditions.
• Tests related to reproductive health, including sexually transmitted diseases.

There are situations, however, when a provider may have to notify a minor’s parents or legal sponsor. These include:
• Life-threatening conditions
• Conditions that may require removing reproductive organs
• Changes in behavior that may cause harm to themselves or others.

For more information, refer to the Parental Access to Protected Health Information of Unemancipated Minors Memorandum. If you’re overseas, go to the Minors and Reproductive Health Care Services (Overseas) Memorandum. Call your military hospital or clinic to speak with its records department if you have questions about accessing your child’s PHI.

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