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JAWM Absurd California Medical Law


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Update/More information  :   I've been searching online today and all I can find re: teens and confidentiality relates to sexual health, abortion, and that type of thing.

 

I'm seriously beginning to wonder if this clinic is using the state and federal privacy laws to create even stricter anti-parent guidelines.  

 

 

 

This is a vent.  I am angry.  Please don't play devil's advocate for the state, because the state is wrong.

 

I took 11 yo DD to the doctor today.  The health clinic is instituting a new online patient care portal to access lab results, scheduled appts., etc. I like this.  What I don't like is what is on the consent form I had to sign.  I learned a whole lot about my rights (or not) to access her medical records once she turns 12.

 

"A.  Minor Eligibility

References to minors between the ages of 12-17 are inclusive.  By California State Law, patients between the ages of 12-17 have the right to their own private information and they do not need to share with their parent/guardian.  An individual must be age 12 or older to request a [HealthClinicName] NextMD Patient Portal account.  Parents or guardians of children may request access to the child's account by following the terms outlined the "Patient Portal Caregiver Access Request Form" section.  At [HealthClinicName] there will be no caregiver authorization for minor children between the ages of 12-17.  In the case for emancipated minors, a court order must be presented as proof before a caregiver authorization can be approved.  Exemptions are given to patients ages 12-17 if there is legal documentation provided by court or legal documentation from a provider or a specialist proving severe mental disabilities or mental retardation of the patient, rendering it impossible for the patient to make clear health care decisions on their own.

 

...

 

C.  Caregiver Termination

A patient 18 years of age or older will have the right to terminate any caregiver access anytime they please, unless otherwise stated by legal documentation.  Minors at the age of 11 will be sent a letter to their physical home address notifying them of their rights at between the ages of 12-17.  Before the minor's 12th birthday all parent(s)/guardian(s) and caregiver access will end absent a valid court order and/or proof from a specialist physician stating extreme health incapacities or mental retardation."

 

How the bolded was explained to me:  Shortly before her 11th birthday the account password will expire and DD will have to set up a new account.  At this point it's up to her if she chooses to share the password with me or not.  period.  They won't authorize caregiver access unless she's mentally unable to make her own medical decisions.

 

So I went online and researched some more and my heart broke.  Raped?  No, your parents don't have a right to know.  Pregnant?  Same deal.  Abortion?  Of course you don't need parental consent.  Have HIV or another STD?  Same deal.  Receiving treatment for drug or alcohol abuse?  Parents have no right to see your medical records related to that either (some exceptions sort of exist for the drug/alcohol thing... kind of).

 

My daughter pointed out to me the irony of needing my consent to get her ears pierced but not to have an abortion.  If only our state legislature were as wise as she.

 

Sometimes I really hate this state.

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I won't play devil's advocate, not because you asked us not to, but because I find this truly horrifying and sickening.

 

At least your dd sounds like she has a level head on her shoulders and hopefully understands that she can and should come to you for help dealing with her health until she is mature enough to make those decisions on her own.

 

:grouphug:

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12 years old???  My teenagers are barely mature enough to feed and bathe themselves regularly, let alone make medical decisions!  That is scary. I am sorry.  I agree with you. 

 

But of course, I am sure you are still expected to pay for everything.

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Yes I am shocked by this and thoroughly displeased. My 11yo and I have already discussed what is wrong with this. Ours does allow for him, at 12, to sign permission for us to access his records. I would look for a new clinic because I don't think they can deny your DD (at 12) signing a form allowing you access.

 

How many 12yos know their families medical history?? Would they remember, oh we have a family history of allergy to penicillin, so I should ask for a different prescription for that infection?

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Would a different clinic handle things differently? Eg, would they seek to facilitate the Caregiver Access Form whereas the clinic that you're at now seems to go beyond the law and won't allow Caregiver access, even if the child consented.

 

I can see where it kinda burns your backside when the parent/guardian is called a "Caregiver" but given no info about what care is needed. Who dispenses a 13yo's meds (since some of tem can't even remember daily deodorant), who pays for medical care (it ain't the kid!), who has to deal with side effects of meds or treatments if they occur at home and get a kid to ER? It's not the doctor or the state. This just seems to feed into the Doctor-God complex and could make a lot of children susceptible to abuse of authority by doctors.

 

They really need a better term than Caregiver. Does "Noseybutt Who Pays the Bills and Provides Transportation" work better? I'm sorry you're dealing with this. There are practices I've refused to go to, even though I liked some of their healthcare philosophy, because they removed a parent or patient advocate from the child's visit at such a young age.

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  Parents have no right to see your medical records related to that either (some exceptions sort of exist for the drug/alcohol thing... kind of).

 

You still get the bill though and can match the medical billings codes on the bills.   I do understand your annoyance but it is not just California. I come from a country that seeing a doctor is not insurance dependent and my parents don't even know who I see since everything is paid by cash/debit card. 

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One thing we ran into is that the age is 12 in CA and the federal law states that to have an online account the child must be 13. We have Kaiser and they push to do everything online and form the age of 12 -13 you can't. You can not have access to them via your account and they cannot setup their own. So on top of all the heinousness quoted above I can't email her dr. not set appointments, or order perscription refills.

 

Also, (although DD can waive it) they can ask me to stay in the waiting room for the first 10 minutes of the appointment. 

 

Yuck. just yuck.

 

 

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Wow, our doctor's office just gives 12 yo minors the form to sign to give their parents access. They can refuse to sign it, but the general assumption is that they will sign it. It sounds like your provider goes beyond what the law requires by not allowing waivers. We live in NC, but the federal HIPPA law is what gives 12-17 yos the right to health care privacy.

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Hmmm.... you made me wonder what my state's laws were like.

 

I'm not sure that it bothers me, because if I don't have a good enough relationship with my kids that they won't share this info with me....then there are bigger issues.  I can see how/why it would bother you, though.  

 

I think the guidelines, though are flawed from a practical standpoint.   I just can't imagine stuff like drug treatment/alcohol treatment being able to exist with a parent's consent.  Um...where is Johnny? Oh, I'm sorry, we can't tell you.  (He's in a residential treatment facility.)  Treatment for STDs? Yes, they can get tested/whatever....but for treatment?. It's an RX...but can kids at 12 really drive themselves to the store and have the cash for copays and such?  So what happens? You don't know that your child has an STD, and they're unable to get the treatment to protect themselves from long-term fertility problems or whatever? How is that good??   Birth control? Yup, but similar issues--especially under 16.  Even abortion access? Yup--but they might need an adult to give them a ride.  While I understand the need for teens to have some privacy, I'd like to see policies amended in such a way that, at minimum, for multiple abortions or multiple STDs, a parent should be informed.  Because obviously, there's some basic learning on how to prevent pregnancy or STDs that is not happening....or the teen is getting into unsafe situations.

 

I'd be far more comfortable with this at 14 or preferably 16.  Quite frankly, if a 12 year old needs birth control or needs STD testing or needs an abortion....there's already a problem.  I wonder how that fits with state consent laws, too?

 

DS is 11-1/2.  Off to see what FL laws are.  

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This actually confuses me now that I think more about it.  Does this mean that 13 year olds would have to have a designated or court approved medical POA in case of a medical emergency in which they cannot give consent for treatment because they are unconcious?  But, I didn't think a minor could execute such documents until age 18.   I obviously have not researched this but I intend to in the next few years before dd reaches that age!

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OK....looking for FL laws, led me to this site which deals with California laws.

 

http://www.teenhealthlaw.org/confidentiality/

 

 

This site deals with Florida, PA, Maine, Illinois, Mass, Missouri, NM, NY, NJ, Kansas, Wisconsin, Georgia, and OH

http://prh.org/minors-access-cards/

 

Seems to be mainly around reproductive health, though.

 

Edited...Florida is saner than I expected.  16+ or married to give consent.  Exceptions are made for birth control and STD testing/tx.  For abortions, one parent must be notified.  Child can seek a court exemption to the parental notification, though.  

 

 

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It's not just California. We use mychart for the children's hospital in Colorado for DD2 and there's a note right in it that at 14 we as parents lose access to the info in the account. 

 

This is good to know as I recently requested some records for my ds12 from there.  I haven't read the thread closely - anyone know whether this applies to ordinary records requests or just online accounts?  I have been feeling reluctant to open up patient portal accounts anyway.

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privacy laws for minors concerning sex, sexuality and addiction have been in place for a very long time. The HIV epidemic in the 1980s only added to it. I am almost 50 and that was the case when I was growing up.  This isn't new and it isn't only California.

 

I am sorry that it is upsetting to you, but I am not sorry that kids who are not in loving and caring homes can get the care they need when they need it. But, think of it this way, if you have a non-judgemental and open relationship with your kids, there is every chance they will share all that information with you anyway.

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DS is 11-1/2.  Off to see what FL laws are.  

 

Not sure about the laws (I'm in FL too) but in our case 12 is the age but it means very little at our children's clinic and hospital. The clinic has a parent portal that I can access until they are 18. When my now 20 yr old turned 18 he was still being seen for surgical followup there. He could have signed paperwork for me to continue to have access. It wasn't necc. When I call insurance or the hospital they will ask me "Do you have permission to speak about her (dd16)?" I ask if they want her to get on and verify it and I'm told "No - we just needed to ask". Cracks me up every time. This is a well known and respected clinic and hospital system. 

 

I have no problem accessing any and all records up to the age of 18. Honestly, the idea of not having access is absurd to me. Especially, as someone pointed out, we're still paying the bills. 

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This is good to know as I recently requested some records for my ds12 from there.  I haven't read the thread closely - anyone know whether this applies to ordinary records requests or just online accounts?  I have been feeling reluctant to open up patient portal accounts anyway.

 

Not sure, sorry!

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I am sorry that it is upsetting to you, but I am not sorry that kids who are not in loving and caring homes can get the care they need when they need it. But, think of it this way, if you have a non-judgemental and open relationship with your kids, there is every chance they will share all that information with you anyway.

 

This is a true point. Dh works with children everyday in just this type of situation. I, too, am glad they can get the help they need. 

 

My children tell me everything so the laws wouldn't be an issue if they were in place but for a child with a not so good relationship with parents it is a good thing IMO.

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This is the part that means I have no trouble agreeing.

 

At [HealthClinicName] there will be no caregiver authorization for minor children between the ages of 12-17.  I"

 

If it were like the other poster said works for her, where they present the form and the kid signs it then I'd have been thinking"That is just the way it is".

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I'm really conflicted about this.

 

I am in favor of teens being able to obtain medical help when they don't feel able to include their parents. I am in favor of kids having a chance to talk to the doctor without a parent present. Some kids have legitimate reason to fear their parent's involvement, especially in things related to sexuality and mental health. Some kids are just shy about their bodies, and may hide concerns if a parent is present (eg. child with a yeast infection). But completely disallowing access to all medical records seems to be taking it a bit far.

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This is scary, but it did just open up a conversation between my 11 year old and myself. I asked her at what age, should she be able to go to the doctor and not have me be able to get information about the visit and what is wrong. She replied "16 or 18, no later than 18". And then I told her why I was asking and she was shocked.

 

Then I looked up Washington's laws. Have not come across age for typical doctor's visits, however for birth control and/or abortion, there is no age at which they need consent from a parent or guardian. For STDs consent is still needed for under 14.

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Hmm.  My question would be where will those minor children be getting their insurance from then.  And rides to the clinic.  And who exactly will be paying for their prescriptions.  Because last time I checked, that was a parent's responsibility and if one is expected to provide all this care, then one should be involved in medical decisions for that child.  

 

What a ridiculous law!  Mental note not to move to CA.

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Hmm.  My question would be where will those minor children be getting their insurance from then.  And rides to the clinic.  And who exactly will be paying for their prescriptions.  Because last time I checked, that was a parent's responsibility and if one is expected to provide all this care, then one should be involved in medical decisions for that child.  

 

What a ridiculous law!  Mental note not to move to CA.

I ran away at 15 and was on BC for an irregular cycle. I went to PPH and they just *gave* me whatever I wanted. They would have given me STD testing, treatment, an abortion. Tax dollars I guess.

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I'm really conflicted about this.

 

I am in favor of teens being able to obtain medical help when they don't feel able to include their parents. I am in favor of kids having a chance to talk to the doctor without a parent present. Some kids have legitimate reason to fear their parent's involvement, especially in things related to sexuality and mental health. Some kids are just shy about their bodies, and may hide concerns if a parent is present (eg. child with a yeast infection). But completely disallowing access to all medical records seems to be taking it a bit far.

 

I agree with this assessment....and 12 seems really young for such a complete cut-off age.

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My daughter has hypothyroidism.  She gets blood tests every 6 mos.  I'm wondering how this will effect me being able to monitor her lab results.  Even results in the normal range can be "high normal" and I'd surely want to discuss that with her doctor.  So, I guess I just keep hoping that she always gives me the password.

 

I get the need to have a private conversation with a doctor or nurse about embarrassing questions or concerns.  NO problem with that.  But, at the end of it all, if there's a legitimate problem the doctor/nurse needs to be able to help DD *talk to me* so I can support her and make sure she has what she needs to stay healthy and safe.

 

I have so much more to say, but no words left.  I think it's possible that some of the restrictions (no caregiver access) are clinic-specific because they receive A LOT of government money.  So maybe that has something to do with it.  I don't know.  

 

 

 

 

 

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My daughter has hypothyroidism.  She gets blood tests every 6 mos.  I'm wondering how this will effect me being able to monitor her lab results.  Even results in the normal range can be "high normal" and I'd surely want to discuss that with her doctor.  So, I guess I just keep hoping that she always gives me the password.

 

I get the need to have a private conversation with a doctor or nurse about embarrassing questions or concerns.  NO problem with that.  But, at the end of it all, if there's a legitimate problem the doctor/nurse needs to be able to help DD *talk to me* so I can support her and make sure she has what she needs to stay healthy and safe.

 

I have so much more to say, but no words left.  I think it's possible that some of the restrictions (no caregiver access) are clinic-specific because they receive A LOT of government money.  So maybe that has something to do with it.  I don't know.  

 

You do realize there is nothing in the information provided that prevents the bolded, right?

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My DD signed a form allowing us access to her medical files.  We were warned by the insurance company when she was younger.

 

I was very upset the first time the took my DD off for what they told me was an eye and ear check and they gave her a private form to fill out asking all sorts of questions that I wasn't supposed to know about.  My DD was very upset and embarrassed by some of the questions that they were asking.  In my state the age for sexual and mental health privacy rights is 14, although as stated in a previous post all children regardless of age can get BCP and an abortion at any age.  I don't like the sneaking around that they do and honestly if my DD didn't need a doctor to sign her physical form for camp I wouldn't take her in each year, same for my DSs when they get to that age.

 

I was livid this year when they gave my 12 year old son the same questionnaire my DD got and it had all sorts of thing that were very personal and he didn't understand half of it.  I was glad DD was there at least to help him.  When the doctor asked me to leave the room so she could talk to DS privately I refused.  She then refused to go over his questionnaire without his consent, which he was quick to give. It was very upsetting to both of us.  It really feels so intrusive and like it is trying to create a barrier and secretiveness between parents and children.

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You do realize there is nothing in the information provided that prevents the bolded, right?

I do realize that my daughter would not be required to tell me, even if it was serious.   A doctor may (or may not) encourage her to communicate, but at the end of the day it would be up to my child to decide whether or not to let me know.

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In my state I have access to my minor son's medical records unless it is pertaining to birth control, STI treatment, HIV testing and treatment, and addiction. If he is sick with strep throat etc then the doctor and anyone else can talk to me without needing a ROI. 

 

When he is 18 he will sign a blanket ROI with my name and my dh's name on it and we will sign one giving him access to our medical records as well. He will be an adult and if there is ever a situation where DH and/or I are unable to speak for ourselves we want him to have full access to our care providers.

 

To the OP, if you want access to the medical records, ask if your daughter can sign a ROI that will allow you access to information regarding her medical treatment. It can specifically rule out sharing information about addiction and sex and sexuality issues, so your daughter will have some privacy but you can have access. Our family doctor does it as a matter of course. For example, I signed one with my dh's name and my mother's name. I wanted her in the loop if something ever happened to me.  He also explains the privacy laws to the teen and the parent together. He explains what he is and is not allowed to share and under what circumstances.

 

 

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I do realize that my daughter would not be required to tell me, even if it was serious.   A doctor may (or may not) encourage her to communicate, but at the end of the day it would be up to my child to decide whether or not to let me know.

 

And nothing in the law prevents her from telling you, correct?  Or having you join her in the doctor's office?

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Weird. I took my dd12 to the doctor on Tuesday - Kaiser - and there was nothing like this. They called me and made the appointment, they handed me the forms & questionaire to fill out, I was in the room the whole time, and the doctor directed advice re: immunizations, etc. to me.  I haven't tried to make an online appointment for her in awhile, but I ran into to nothing like what some of you are describing. (I'm in CA, btw).

 

ETA: What happened to the OP would have bugged me, too.  I'm just surprised that if it is a state law it clearly isn't being applied uniformly?

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OP, I am thinking that your clinic may have been a bit over zealous about implementing this??? Liking adding stuff to the wording??

Because how exactly does this work if you 12yo is in a car accident and unconscious?? They can't execute a medical POA as far as I can see because they aren't 18 (so wouldn't be binding, not even sure a notary would notarize it).  So the hospital couldn't release info ?? Who would make medical decisions for them if they didn't already have a signed form on record giving DRs permission to talk to the parents??? I think whoever wrote this regulation was not thinking it through AT ALL.

 

DS and I discussed this the other day and he said "who's stupid Idea was this? I wouldn't know what questions to ask if they told me you have ______ condition. That is what my mom is for. To take care of me."

 

 

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So kids 12 and older are supposed to make their own medical decisions? Surely I'm misunderstanding.

 

Here in our state a 17yo wanted to refuse cancer treatment and pursue alternative therapies. Her mother decided that since her daughter was nearly an adult that she would support that decision. The Dr. disagreed and the state took custody of the girl and forced her to receive traditional cancer treatment.

 

Without getting into the debate about traditional vs. alternative medicine, how would this have played out in a state like CA? Would a 12 year old simply be allowed to make a medical decision to refuse or accept treatment? What if they refused? Would the state step in and make decisions for them? Would the parents be informed?

 

I'm just completely baffled by this. At 8 years old kids have to be in our line of sight at all times and by 12 they can manage their own medical care? Truly unbelievable.

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So kids 12 and older are supposed to make their own medical decisions? Surely I'm misunderstanding.

 

Here in our state a 17yo wanted to refuse cancer treatment and pursue alternative therapies. Her mother decided that since her daughter was nearly an adult that she would support that decision. The Dr. disagreed and the state took custody of the girl and forced her to receive traditional cancer treatment.

 

Without getting into the debate about traditional vs. alternative medicine, how would this have played out in a state like CA? Would a 12 year old simply be allowed to make a medical decision to refuse or accept treatment? What if they refused? Would the state step in and make decisions for them? Would the parents be informed?

 

I'm just completely baffled by this. At 8 years old kids have to be in our line of sight at all times and by 12 they can manage their own medical care? Truly unbelievable.

 

 

Me, too, and I'm the OP.   I've been searching online today and all I can find re: teens and cofidentiality relates to sexual health, abortion, and that type of thing.

 

I'm seriously beginning to wonder if this clinic is using the state and federal privacy laws as a cover to create its own even stricter anti-parent guidelines.  

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Weird. I took my dd12 to the doctor on Tuesday - Kaiser - and there was nothing like this. They called me and made the appointment, they handed me the forms & questionaire to fill out, I was in the room the whole time, and the doctor directed advice re: immunizations, etc. to me.  I haven't tried to make an online appointment for her in awhile, but I ran into to nothing like what some of you are describing. (I'm in CA, btw).

 

ETA: What happened to the OP would have bugged me, too.  I'm just surprised that if it is a state law it clearly isn't being applied uniformly?

 

We have Kaiser in CA as well. We haven't used their services for the kids because we prefer our friend who's a non-Kaiser pediatrician but we keep the coverage for emergencies, hospitalizations, etc. My DD has never been to the Kaiser doctor and our DS only once for an urgent matter when our doctor was on vacation.

 

However, I did sign them up for the online Kaiser web site and it warned me I would lose access to the records in the future when they turn 12. I'm pretty sure that will be an automatic computerized process to lock me out.

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We have Kaiser in CA as well. We haven't used their services for the kids because we prefer our friend who's a non-Kaiser pediatrician but we keep the coverage for emergencies, hospitalizations, etc. My DD has never been to the Kaiser doctor and our DS only once for an urgent matter when our doctor was on vacation.

 

However, I did sign them up for the online Kaiser web site and it warned me I would lose access to the records in the future when they turn 12. I'm pretty sure that will be an automatic computerized process to lock me out.

 

Yeah, ok, I checked the website and it did automatically kick me off as her caregiver when she turned 12.  I just renewed myself till 2020, but with limited ability to do things for her online.  Of course she can't get her own online account until she is 13 . . . so I guess that is why they called me to set up her appointment.  I still find it weird. No one said a word to me about this at the appointment, nor did they make an effort to exclude me in any way.  I just can't get online access to her medical records, test results, etc.  I can live with that - her doctor is still fully welcoming me into the process.  As is my dd, FWIW.    

 

Here is what it said on the FAQ page:

 

Why can I see more records for my young child than for my teen?

Under state laws, teens are entitled to additional privacy. Once your child reaches a certain age — usually 12, 13, or 14 — we show you your teen’s online records as state law allows. Note that in California the age is 12.

My teen’s records aren’t available online because he or she is over the limit set by state law. What are my options?

Under state laws, teens are entitled to additional privacy, but you can request hard copies of your teen’s records at the facility where he or she gets care. Kaiser Permanente will provide records as allowed by state law.

Can my children get their own kp.org accounts?

Children 13 years of age or older can register for their own accounts.

Children under 13 can’t register for their own accounts because the Children’s Online Privacy Protection Act (COPPA) says that Kaiser Permanente must have parental permission to collect personal information from anyone under 13 years of age.

Can my teen give me permission to view his or her records?

We're sorry, but currently we can't offer a way for your teen to give permission.

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