By Ann Bermudez, Army Medicine Public AffairsAugust 21, 2015
FORT SAM HOUSTON, Texas (Aug. 21, 2015) -- The U.S. Army Medical Command, or MEDCOM, wants to ensure the correct individuals have access to minors' medical records and information.
A recent memo implemented general guidance from the Defense Health Agency Privacy and Civil Liberties Office to help define what custodial and non-custodial parents as well as stepparents have access rights to a minor's medical information. It also helps the Army military treatment facilities, or MTFs, apply appropriate safeguards as it relates to the release of Protected Health Information, or PHI.
In addition, MEDCOM wants to make sure reasonable efforts are made to prevent any use or disclosure of PHI of a minor to a custodial or non-custodial parent or stepparent that would be in violation of the Health Insurance Portability and Accountability Act, or HIPAA, Privacy Rule.
Thomas Leonard, health systems specialist for the Patient Administration Division, Patient Care Integration, U.S. Army Medical Command said the Department of Defense's Health Information Privacy Regulation, DOD 6025.18-R, C8.7.3, and HIPAA Privacy Rule, 45 CFR 164.502(g)(3) establish the requirement for the release of PHI of minors to custodial and noncustodial parents as well as stepparents. Adoptive parents are considered to be custodial or non-custodial parents.
In situations of divorce, the MTF shall treat each parent as a personal representative of the minor, regardless of which parent has custody, unless there is a limitation on one parent's custody stated in the divorce decree. A request to restrict one parent's access to the PHI of a minor is only granted upon presentation of a legal document. For example, in cases of child abuse or neglect, a divorce document or other court document may state that the non-custodial parent is not authorized to access the minor child's medical information. The Military Health System must honor such request.
The MTF staff must be vigilant in ensuring that sponsor information is not given to a parent making inquiries into a minor's health record, as the parent may have no right to the sponsor's information.
A stepparent is not a biological parent. Rather, a stepparent is related to the child only by marriage to a biological or adoptive parent. There are cases where stepparents may attempt to become involved in the care of a minor child. Under the HIPAA Privacy Rule, a stepparent has no right to serve as the personal representative of a minor, unless an appropriate healthcare power of attorney or a HIPAA compliant authorization (DD Form 2870) has been provided to the stepparent.
Within the military community, many minor children are covered by TRICARE under a stepparent's eligibility. This can occur when a custodial parent remarries a TRICARE sponsor and this sponsor becomes the minor's stepparent. However, this does not give the stepparent (if he/she has not been given a healthcare power of attorney or HIPAA compliant authorization) the right to act as the personal representative for that minor to obtain PHI.
A matrix of DEERS access, access to medical records, and appointment making authorization for custodial and non-custodial parents as well as stepparents is available.