OBJECTIVES:

Health care providers managing the complex health needs of adolescents must comply with state laws governing adolescent consent and right to privacy. However, these laws vary. Our objectives were to summarize consent and privacy laws state-by-state and assess the implications of variation for compliance with the 21st Century Cures Act and with evidence-based guidance on adolescent care.

METHODS:

We summarized state laws and regulations on minor consent for the following: health services, substance abuse treatment, prenatal care, mental health care, contraceptive management, immunizations, sexually transmitted infection management, human immunodeficiency viruses testing and treatment, dental care, and sexual assault evaluation. We compared state laws and regulations with American Academy of Pediatrics’ evidence-based guidelines to assess consistencies in guidance.

RESULTS:

We observed notable state-by-state variability in laws governing consent for adolescent patients. No states had identical policies for all services studied. For example, although all states had provisions for consent to management of sexually transmitted infections, there were variable specifications in the age and type of minor, whether this includes human immunodeficiency viruses, and whether confidentiality is protected. Providing confidential care to the adolescent patient has been set as a priority by medical societies; however, guidelines are limited by the need to comply with state laws and regulations.

CONCLUSIONS:

State laws on consent and privacy for adolescents are highly variable, and many do not reflect pediatric professional standards of care. This inconsistency is a barrier to operationalizing a consistent and equitable experience providing evidence-based medical care and ensuring adolescent privacy protection.

What’s Known on This Subject:

States have independently developed laws and regulations on adolescent consent and privacy around healthcare access based on age and the type of care the adolescent is seeking. These laws and regulations are complex and vary from state to state.

What This Study Adds:

This study highlights variability in state consent laws, which complicates their interpretation and management when intersecting with HIPAA regulations, the 21st Century Cures Act, and evidence-based care recommendations for protecting health data privacy and the protection of adolescent health information.

A rich evidence base demonstrates that adolescents are more likely to seek health care for potentially sensitive issues such as sexuality, mental health, and drug use if they can provide their own consent and be confident that their health information is private.18  However, parents and guardians also have responsibilities pertaining to care for minor patients. Long-established state laws are often inconsistent in how they address these conflicting objectives, resulting in varying regulations from state to state.9,10 For example, adolescents in some states can consent to their own healthcare if they have reached a certain age or are parents themselves, and in others, they can only consent to specific types of sensitive healthcare within the domains of reproductive health, sexually transmitted illnesses (STIs), or substance abuse. There are also persisting inconsistencies in privacy and confidentiality protection by state.1014  Although the best clinical practices to support adolescent autonomy should transcend state lines, state law variations make it nearly impossible to provide the privacy protection that is supported by medical societies, including the American Academy of Pediatrics (AAP), to support adolescent autonomy.

Adolescent privacy concerns have increased with the expanded use of electronic health records (EHRs), as well as with the advent of Open Notes15 and the 21st Century Cures Act, which has a focus on increasing electronic health information and reducing information blocking.16,17 In general, when there is a conflict between the state and federal laws, the state laws take precedence. However, this is not a consistent hierarchy and is complicated by variable state laws.

Collectively, these efforts have increased the transparency of health records and made them more available to patients and caregivers, such as parents or guardians. Unprecedented access to electronic health information raises the potential for breaches of privacy laws and confidentiality regulations.18 Also, with increasing EHR interoperability, the data collected under the laws of 1 state may be transferred to other states with different laws. It is often the responsibility of health care providers to ensure that medical consent and access to health information is done in compliance with state and federal laws, yet providers are often unaware of what services a minor can access confidentially according to state laws.19 

EHRs have not yet consistently developed the ability to reliably protect sensitive information, particularly when transferring from 1 state to another.2024  Due to the complexities of providing privacy protection that complies with complex state laws, some medical centers have shut down health information access during adolescence.10 This creates inequities in access to health care information for adolescents at a time of unique medical vulnerability.2530 

Our objectives were to summarize state-by-state adolescent consent laws to illustrate variability of policies, and to examine these laws in the lens of evidence-based guidance and expert consensus about optimal care for adolescents. Although the AAP values and promotes the provision of confidential healthcare for adolescent patients, guidance on the practical details of consent and privacy protection generally defers to state laws and regulations.29,3135 

We used a variety of sources to construct Table 1, which provides a summary of state-by-state minor consent policies for the following services: general medical care, immunizations, dental care, sexual assault evaluation, STI testing and treatment, human immunodeficiency viruses (HIV) testing and treatment, contraceptive care, prenatal care, substance abuse treatment, and mental health care.

TABLE 1

State-by-State Policies on the Ability for Minors to Consent for Medical Services

StateGeneral Medical
Care
Immunizations
(see Figure 2)
Dental CareSexual Assault EvaluationSTI Testing and TreatmentHIV Testing and TreatmentContraceptive CarePrenatal CareSubstance Abuse TreatmentMental Health Care
Alabama If 14 y or older or graduated high school, ever married or pregnant. Age of maturity is 19 y Yes, if 14 y or older or graduated high school 14 y or older or graduated high school, ever married or pregnant No explicit policy Yes, if 12 y or oldera Yes, if 12 y or oldera 14 y or older or graduated high school, ever married or pregnant Yes Yes 14 y or older or graduated high school, ever married or pregnant 
Alaska If emancipated, living apart and financially independent, married or parents. Otherwise, if parent cannot be contacted or unwilling to give consent Yes, if parent cannot be contacted or won't grant consent If emancipated, living apart and financially independent, married or parents. Otherwise, if parent cannot be contacted or unwilling to give consent No explicit policy Yes No Yes Yes No explicit policy No explicit policy 
Arizona If emancipated, married, or homeless No, unless court ordered No Yes, if 12 y or older Yes No Yes No explicit policy Yes, if 12 y or older No explicit policy 
Arkansas If emancipated, married, incarcerated, or if have sufficient intelligence to appreciate the consequences of treatment Yes, if mature minor No explicit policy No explicit policy Yesa No Yes Yes If they have sufficient intelligence to appreciate the consequences If they have sufficient intelligence to appreciate the consequences 
California If 15 y or older, living separately and financially independent, or 12 y or older if in contact with infectious, contagious, or communicable disease Yes, if 12 or older for HPV, Hep B (or COVID-19 in San Francisco) 15 y or older Yes, if 12 y or older Yes, if 12 y or older Yes, if 12 y or older Yes Yes Yes, if 12 y or oldera Yes,a if 12 y or older and is mature enough to participate intelligently and is in present danger or victim of incest or child abuse 
Colorado If 14 y or older, living separately and financially independent No If 14 or older, living separately and financially independent Yes Yes, if 13 y or older Yes, if 13 y or oldera Yes Yes Yes Yes, if 15 y or oldera 
Connecticut If emergency case, emancipated or married No Yes, if married, or emancipated minor, or a parent. No explicit policy Yes, physician must report positive result if younger than 12 y Yes, physician must report positive result if younger than 12 y Yes, if married No explicit policy for unmarried minors Yes Yes 
Delaware If married, pregnant, in an emergency, or 12 y or older with infectious diseases Yes, if 12 y and older, except COVID-19 Yes, if married or pregnant No explicit policy Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if 14 y or older for outpatient No explicit policy 
Florida If 16 y or older and emancipated, or married, homeless, or living apart and financially independent No 16 y or older and emancipated, or married, homeless, or living apart and financially independent No explicit policy Yes Yes Yes, if married, a parent, pregnant or ever pregnant Yes Yes Yes, if 13 y and older 
Georgia If emancipated or married No Yes, for emancipated minor No explicit policy Yesa Yesa Yes Yes Yesa No explicit policy 
Hawaii If 14 y or older, not under the control of a legal guardian, with informed consent, and care is for minor's benefit no 14 y or older, not under the control of a legal guardian, with informed consent, and care is for minor's benefit No explicit policy Yes, if 14 y or oldera No Yes, if 14 y or oldera Yes, if 14 y or oldera Yesa Yes, if 14 y or older 
Idaho If able to comprehend the nature of and risks of treatment Yes, if mature minor If able to comprehend the nature of and risks of treatment If able to comprehend the nature of and risks of treatment Yes, if 14 y or older Yes, if 14 y or older Yes Yes Yes,a Info may be shared with parent if younger than 16 y Yes, if 14 y or older 
Illinois If 14 y and older and emancipated, understands benefits and risks, identified by a listed representative, or married, pregnant or a parent Yes, if 12 y or older for HPV or Hep B Emergency dental care Yes Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if married, a parent, pregnant or ever pregnant, or referred Yes Yes, if 12 y or older Yes, if 12 y or older, 16 or older for inpatienta 
Indiana If emancipated, 14 y old and financially independent and living apart from parents, married, or in the military. No No explicit policy Yes Yes No Yes, if married No explicit policy for unmarried minors Yes No explicit policy 
Iowa If 16 y or older and emancipated, or married, or incarcerated as an adult Yes, if 12 y or older for HPV or Hep B No explicit policy Yes, treatment information cannot be kept confidential from parent Yes Yes, parent must be notified for a positive result Yes No explicit policy for unmarried minors Yes No explicit policy for general mental health; may consent to immediate or short-term mental health services if a victim of sexual assault or sexual abuse 
Kansas 16 y or older No Yes if, 16 y or older Yes Yesa No Yes, if mature minor Yes, if mature minor Yes No explicit policy 
Kentucky If emancipated, married, or parent No If emancipated, married, or parent Yes Yesa Yes Yesa Yesa Yesa Yes, if 16 y or oldera 
Louisiana Yes Yes, except COVID-19 No explicit policy No explicit policy Yesa No Yes, if married No explicit policy for unmarried minors Yesa No explicit policy 
Maine If living independently, or married, or in the Armed Forces, or emancipated No If living independently, or married, or in the Armed Forces, or emancipated Yes Yesa No Yesa Yesa Yesa Yesa 
Maryland If married, a parent, living independently, or in an emergency No If married, a parent, living independently, or in an emergency Yes Yesa No Yesa Yesa Yesa Yes, a minor 12 y or oldera 
Massachusetts If emancipated, living apart from parents, ever married, pregnant, or a parent; or has a disease dangerous to public health No If emancipated, living apart from parents, ever married, pregnant, or a parent; or has a disease dangerous to public health No explicit policy Yes, parent must be notified if minor's health or life at risk No Yes, not through state funding Yes, parent must be notified if minor's health or life at risk Yes, if 12 y or older Yes, if 16 y or older 
Michigan If emancipated, living apart from parents, ever married, pregnant, or a parent No If emancipated, living apart from parents, ever married, pregnant, or a parent Yes Yesa Yesa Yes, if married Yesa Yes, if 14 y or older Yes, if 14 y or older 
Minnesota If living independently, married, pregnant, a parent, or in an emergency Yes, only for Hep B If living independently, married, pregnant, a parent, or in an emergency No explicit policy Yesa No Yesa Yesa Yesa Yes, if related to pregnancy, venereal disease, or alcohol and other drug abuse 
Mississippi If married or emancipated No No explicit policy No explicit policy Yes Yes, but does not include treatment Yes, if married or a parent or referred Yes Yes, if 15 y or oldera No explicit policy 
Missouri If married, parent, or pregnant No No explicit policy Yes Yesa No Yes, if married Yesa Yesa No explicit policy 
Montana If emancipated, married, a parent, graduated from high school, or living apart from parents Yes, if married, a parent, or graduated high school, except for COVID-19 Yes, if delay in care would endanger health No explicit policy Yesa Yes Yesa Yesa Yesa Yes, if 16 y or older 
Nebraska No explicit policy. *Age of maturity is 19 y No No explicit policy No explicit policy Yes No Yes, if married No explicit policy Yes No explicit policy 
Nevada If living apart from parents, ever married, parent, or health emergency No If living apart from parents, ever married, parent, or health emergency No explicit policy Yes Yes Yes, if married, a parent or a mature minor Yes, if married or mature minor Yes No explicit policy 
New Hampshire Emergency care No No explicit policy No explicit policy Yes, if 14 y or older No Yes, if mature minor Yes, if mature minor Yes, if 12 y or older No explicit policy 
New Jersey If married or pregnant No No explicit policy Yes, if 13 y or older Yesa Yes, 13 y or oldera Yes, if. married, pregnant or ever pregnant Yesa Yes Yes, 16 y or older for outpatient services, excluding medications 
New Mexico If 14 y with capacity to give consent and living apart from parents, or a parent No If 14 y with capacity to give consent and living apart from parents, or a parent No explicit policy Yes Yes, but does not include treatment Yes Yes Yes, if 14 y or older, parents notified if psychotropic medications given Yes, if 14 y or older, parents notified if psychotropic medications given 
New York If parent, married, or in an emergency Yes, only for HPV If parent, married, or in an emergency Yes Yes Yes, but does not include treatment Yes, not through state funding Yes Yesa Yesa 
North Carolina If married, or 16 or older and emancipated, or for emergency care Yes, except for those with emergency use authorization No explicit policy No explicit policy Yes Yes Yes Yesa Yes Yes 
North Dakota Yes, for emergency care. No Yes, if 14 y and homeless Yes Yes, if 14 y or older Yes, if 14 y or older No explicit policy Yes, during first trimester and first visit after first trimester Yes, if 14 y or older No explicit policy 
Ohio No explicit policy No No explicit policy Yes Yes Yes, but does not include treatment No explicit policy No explicit policy Yes Yes, if 14 y or older 
Oklahoma Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy. No Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy. Yes Yesa Yesa Yes, if married, pregnant or ever pregnanta Yesa Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy; 16 y or older for inpatient treatment Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy; 16 y or older for inpatient treatment 
Oregon If 15 y or older Yes, if 15 y or older Yes, if 15 y or older No explicit policy Yes Yes Yesa Yes, if 15 y or oldera Yes,a outpatient: 14 y or older; onpatient: 15 y or older Yes,a outpatient: 14 y or older; inpatient: 15 y or older 
Pennsylvania If married, emancipated, pregnant, or graduated from high school. No, unless 11 y and older for COVID-19 in Philadelphia, and able to consent Yes, if minor is emancipated or has graduated high school, been married or been pregnant. Yes Yes Yes Yes, if 14 y or older Yes Yesa No explicit policy 
Rhode Island If 16 y or older for certain services Yes, if 16 y or older No explicit policy No explicit policy Yes Yes No explicit policy No explicit policy Yes No explicit policy 
South Carolina If 16 y or older Yes, if 16 y or older Yes, if deemed medically necessary No explicit policy Yes, if 16 y or older or mature minor Yes, if 16 y or older or mature minor Yes, if 16 y or older, mature minor or married Yes, if 16 y or older, or mature minor Yes, if 16 y or older, younger when deemed necessary Yes, if 16 y or older, younger when deemed necessary 
South Dakota If married or emancipated No No explicit policy Yes, if 16 y or older Yes No Yes, if married No explicit policy for unmarried minors Yes No explicit policy 
Tennessee If 16 y or older Yes, if 14 y or older, and mature minor Yes, 14 y or older for numerous situations No explicit policy Yes Yes Yes Yes Yesa Yes, if 16 y or older 
Texas If 16 y or older No Yes, if 16 y or older and lives separate from parents or guardians Yes Yesa Yesa Yes, if married Yesa Yesa Yes 
Inpatient: 16 y or older 
Utah If emancipated, married, a parent, or an unaccompanied homeless minor who is 15 y or older No No explicit policy No explicit policy Yes No Yes, if married Yes No explicit policy No explicit policy 
Vermont If emancipated or married No No explicit policy Yes Yes, if 12 y or older Yes, if 12 y and older, but does not include treatment Yes, if married No explicit policy for unmarried minors Yes, if 12 y or older Yes,a outpatient: any age; inpatient: 14 y or older 
Virginia If emancipated, married or a parent No If emancipated, married, or parent. No explicit policy Yes Yes Yes Yes Yes, for outpatient treatment Yes, for outpatient treatment 
Washington If emancipated, married, or meets criteria for being homeless Yes, if mature minor No explicit policy No Yes, if 14 y or older Yes, if 14 y or older Yes Yes Yes, if 13 y or older for outpatient treatment Yes, if 13 y or older for outpatient treatment 
West Virginia If 16 y and emancipated or married No No explicit policy No explicit policy Yes No Yes, if married Yes, if 16 y or older and married or a mature minor Yes Yes, if 14 y or older 
Wisconsin No explicit policy No No explicit policy Yes Yes No No explicit policy No explicit policy Yes,a if 12 y or older and the parent cannot be found. The parent or guardian must be notified at soon as possible. Yes, if 14 y or older 
Wyoming If emancipated, is or was married, in the military, or living apart from parents and managing their own affairs No No explicit policy Yes, if parent or guardian cannot be located Yes Yes Yes, not through state funding No explicit policy for unmarried minors Yes * If 12 y or older and is a smoker or user of tobacco products No explicit policy 
StateGeneral Medical
Care
Immunizations
(see Figure 2)
Dental CareSexual Assault EvaluationSTI Testing and TreatmentHIV Testing and TreatmentContraceptive CarePrenatal CareSubstance Abuse TreatmentMental Health Care
Alabama If 14 y or older or graduated high school, ever married or pregnant. Age of maturity is 19 y Yes, if 14 y or older or graduated high school 14 y or older or graduated high school, ever married or pregnant No explicit policy Yes, if 12 y or oldera Yes, if 12 y or oldera 14 y or older or graduated high school, ever married or pregnant Yes Yes 14 y or older or graduated high school, ever married or pregnant 
Alaska If emancipated, living apart and financially independent, married or parents. Otherwise, if parent cannot be contacted or unwilling to give consent Yes, if parent cannot be contacted or won't grant consent If emancipated, living apart and financially independent, married or parents. Otherwise, if parent cannot be contacted or unwilling to give consent No explicit policy Yes No Yes Yes No explicit policy No explicit policy 
Arizona If emancipated, married, or homeless No, unless court ordered No Yes, if 12 y or older Yes No Yes No explicit policy Yes, if 12 y or older No explicit policy 
Arkansas If emancipated, married, incarcerated, or if have sufficient intelligence to appreciate the consequences of treatment Yes, if mature minor No explicit policy No explicit policy Yesa No Yes Yes If they have sufficient intelligence to appreciate the consequences If they have sufficient intelligence to appreciate the consequences 
California If 15 y or older, living separately and financially independent, or 12 y or older if in contact with infectious, contagious, or communicable disease Yes, if 12 or older for HPV, Hep B (or COVID-19 in San Francisco) 15 y or older Yes, if 12 y or older Yes, if 12 y or older Yes, if 12 y or older Yes Yes Yes, if 12 y or oldera Yes,a if 12 y or older and is mature enough to participate intelligently and is in present danger or victim of incest or child abuse 
Colorado If 14 y or older, living separately and financially independent No If 14 or older, living separately and financially independent Yes Yes, if 13 y or older Yes, if 13 y or oldera Yes Yes Yes Yes, if 15 y or oldera 
Connecticut If emergency case, emancipated or married No Yes, if married, or emancipated minor, or a parent. No explicit policy Yes, physician must report positive result if younger than 12 y Yes, physician must report positive result if younger than 12 y Yes, if married No explicit policy for unmarried minors Yes Yes 
Delaware If married, pregnant, in an emergency, or 12 y or older with infectious diseases Yes, if 12 y and older, except COVID-19 Yes, if married or pregnant No explicit policy Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if 14 y or older for outpatient No explicit policy 
Florida If 16 y or older and emancipated, or married, homeless, or living apart and financially independent No 16 y or older and emancipated, or married, homeless, or living apart and financially independent No explicit policy Yes Yes Yes, if married, a parent, pregnant or ever pregnant Yes Yes Yes, if 13 y and older 
Georgia If emancipated or married No Yes, for emancipated minor No explicit policy Yesa Yesa Yes Yes Yesa No explicit policy 
Hawaii If 14 y or older, not under the control of a legal guardian, with informed consent, and care is for minor's benefit no 14 y or older, not under the control of a legal guardian, with informed consent, and care is for minor's benefit No explicit policy Yes, if 14 y or oldera No Yes, if 14 y or oldera Yes, if 14 y or oldera Yesa Yes, if 14 y or older 
Idaho If able to comprehend the nature of and risks of treatment Yes, if mature minor If able to comprehend the nature of and risks of treatment If able to comprehend the nature of and risks of treatment Yes, if 14 y or older Yes, if 14 y or older Yes Yes Yes,a Info may be shared with parent if younger than 16 y Yes, if 14 y or older 
Illinois If 14 y and older and emancipated, understands benefits and risks, identified by a listed representative, or married, pregnant or a parent Yes, if 12 y or older for HPV or Hep B Emergency dental care Yes Yes, if 12 y or oldera Yes, if 12 y or oldera Yes, if married, a parent, pregnant or ever pregnant, or referred Yes Yes, if 12 y or older Yes, if 12 y or older, 16 or older for inpatienta 
Indiana If emancipated, 14 y old and financially independent and living apart from parents, married, or in the military. No No explicit policy Yes Yes No Yes, if married No explicit policy for unmarried minors Yes No explicit policy 
Iowa If 16 y or older and emancipated, or married, or incarcerated as an adult Yes, if 12 y or older for HPV or Hep B No explicit policy Yes, treatment information cannot be kept confidential from parent Yes Yes, parent must be notified for a positive result Yes No explicit policy for unmarried minors Yes No explicit policy for general mental health; may consent to immediate or short-term mental health services if a victim of sexual assault or sexual abuse 
Kansas 16 y or older No Yes if, 16 y or older Yes Yesa No Yes, if mature minor Yes, if mature minor Yes No explicit policy 
Kentucky If emancipated, married, or parent No If emancipated, married, or parent Yes Yesa Yes Yesa Yesa Yesa Yes, if 16 y or oldera 
Louisiana Yes Yes, except COVID-19 No explicit policy No explicit policy Yesa No Yes, if married No explicit policy for unmarried minors Yesa No explicit policy 
Maine If living independently, or married, or in the Armed Forces, or emancipated No If living independently, or married, or in the Armed Forces, or emancipated Yes Yesa No Yesa Yesa Yesa Yesa 
Maryland If married, a parent, living independently, or in an emergency No If married, a parent, living independently, or in an emergency Yes Yesa No Yesa Yesa Yesa Yes, a minor 12 y or oldera 
Massachusetts If emancipated, living apart from parents, ever married, pregnant, or a parent; or has a disease dangerous to public health No If emancipated, living apart from parents, ever married, pregnant, or a parent; or has a disease dangerous to public health No explicit policy Yes, parent must be notified if minor's health or life at risk No Yes, not through state funding Yes, parent must be notified if minor's health or life at risk Yes, if 12 y or older Yes, if 16 y or older 
Michigan If emancipated, living apart from parents, ever married, pregnant, or a parent No If emancipated, living apart from parents, ever married, pregnant, or a parent Yes Yesa Yesa Yes, if married Yesa Yes, if 14 y or older Yes, if 14 y or older 
Minnesota If living independently, married, pregnant, a parent, or in an emergency Yes, only for Hep B If living independently, married, pregnant, a parent, or in an emergency No explicit policy Yesa No Yesa Yesa Yesa Yes, if related to pregnancy, venereal disease, or alcohol and other drug abuse 
Mississippi If married or emancipated No No explicit policy No explicit policy Yes Yes, but does not include treatment Yes, if married or a parent or referred Yes Yes, if 15 y or oldera No explicit policy 
Missouri If married, parent, or pregnant No No explicit policy Yes Yesa No Yes, if married Yesa Yesa No explicit policy 
Montana If emancipated, married, a parent, graduated from high school, or living apart from parents Yes, if married, a parent, or graduated high school, except for COVID-19 Yes, if delay in care would endanger health No explicit policy Yesa Yes Yesa Yesa Yesa Yes, if 16 y or older 
Nebraska No explicit policy. *Age of maturity is 19 y No No explicit policy No explicit policy Yes No Yes, if married No explicit policy Yes No explicit policy 
Nevada If living apart from parents, ever married, parent, or health emergency No If living apart from parents, ever married, parent, or health emergency No explicit policy Yes Yes Yes, if married, a parent or a mature minor Yes, if married or mature minor Yes No explicit policy 
New Hampshire Emergency care No No explicit policy No explicit policy Yes, if 14 y or older No Yes, if mature minor Yes, if mature minor Yes, if 12 y or older No explicit policy 
New Jersey If married or pregnant No No explicit policy Yes, if 13 y or older Yesa Yes, 13 y or oldera Yes, if. married, pregnant or ever pregnant Yesa Yes Yes, 16 y or older for outpatient services, excluding medications 
New Mexico If 14 y with capacity to give consent and living apart from parents, or a parent No If 14 y with capacity to give consent and living apart from parents, or a parent No explicit policy Yes Yes, but does not include treatment Yes Yes Yes, if 14 y or older, parents notified if psychotropic medications given Yes, if 14 y or older, parents notified if psychotropic medications given 
New York If parent, married, or in an emergency Yes, only for HPV If parent, married, or in an emergency Yes Yes Yes, but does not include treatment Yes, not through state funding Yes Yesa Yesa 
North Carolina If married, or 16 or older and emancipated, or for emergency care Yes, except for those with emergency use authorization No explicit policy No explicit policy Yes Yes Yes Yesa Yes Yes 
North Dakota Yes, for emergency care. No Yes, if 14 y and homeless Yes Yes, if 14 y or older Yes, if 14 y or older No explicit policy Yes, during first trimester and first visit after first trimester Yes, if 14 y or older No explicit policy 
Ohio No explicit policy No No explicit policy Yes Yes Yes, but does not include treatment No explicit policy No explicit policy Yes Yes, if 14 y or older 
Oklahoma Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy. No Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy. Yes Yesa Yesa Yes, if married, pregnant or ever pregnanta Yesa Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy; 16 y or older for inpatient treatment Yes, in an emergency or if married, emancipated, living apart, or has had a pregnancy; 16 y or older for inpatient treatment 
Oregon If 15 y or older Yes, if 15 y or older Yes, if 15 y or older No explicit policy Yes Yes Yesa Yes, if 15 y or oldera Yes,a outpatient: 14 y or older; onpatient: 15 y or older Yes,a outpatient: 14 y or older; inpatient: 15 y or older 
Pennsylvania If married, emancipated, pregnant, or graduated from high school. No, unless 11 y and older for COVID-19 in Philadelphia, and able to consent Yes, if minor is emancipated or has graduated high school, been married or been pregnant. Yes Yes Yes Yes, if 14 y or older Yes Yesa No explicit policy 
Rhode Island If 16 y or older for certain services Yes, if 16 y or older No explicit policy No explicit policy Yes Yes No explicit policy No explicit policy Yes No explicit policy 
South Carolina If 16 y or older Yes, if 16 y or older Yes, if deemed medically necessary No explicit policy Yes, if 16 y or older or mature minor Yes, if 16 y or older or mature minor Yes, if 16 y or older, mature minor or married Yes, if 16 y or older, or mature minor Yes, if 16 y or older, younger when deemed necessary Yes, if 16 y or older, younger when deemed necessary 
South Dakota If married or emancipated No No explicit policy Yes, if 16 y or older Yes No Yes, if married No explicit policy for unmarried minors Yes No explicit policy 
Tennessee If 16 y or older Yes, if 14 y or older, and mature minor Yes, 14 y or older for numerous situations No explicit policy Yes Yes Yes Yes Yesa Yes, if 16 y or older 
Texas If 16 y or older No Yes, if 16 y or older and lives separate from parents or guardians Yes Yesa Yesa Yes, if married Yesa Yesa Yes 
Inpatient: 16 y or older 
Utah If emancipated, married, a parent, or an unaccompanied homeless minor who is 15 y or older No No explicit policy No explicit policy Yes No Yes, if married Yes No explicit policy No explicit policy 
Vermont If emancipated or married No No explicit policy Yes Yes, if 12 y or older Yes, if 12 y and older, but does not include treatment Yes, if married No explicit policy for unmarried minors Yes, if 12 y or older Yes,a outpatient: any age; inpatient: 14 y or older 
Virginia If emancipated, married or a parent No If emancipated, married, or parent. No explicit policy Yes Yes Yes Yes Yes, for outpatient treatment Yes, for outpatient treatment 
Washington If emancipated, married, or meets criteria for being homeless Yes, if mature minor No explicit policy No Yes, if 14 y or older Yes, if 14 y or older Yes Yes Yes, if 13 y or older for outpatient treatment Yes, if 13 y or older for outpatient treatment 
West Virginia If 16 y and emancipated or married No No explicit policy No explicit policy Yes No Yes, if married Yes, if 16 y or older and married or a mature minor Yes Yes, if 14 y or older 
Wisconsin No explicit policy No No explicit policy Yes Yes No No explicit policy No explicit policy Yes,a if 12 y or older and the parent cannot be found. The parent or guardian must be notified at soon as possible. Yes, if 14 y or older 
Wyoming If emancipated, is or was married, in the military, or living apart from parents and managing their own affairs No No explicit policy Yes, if parent or guardian cannot be located Yes Yes Yes, not through state funding No explicit policy for unmarried minors Yes * If 12 y or older and is a smoker or user of tobacco products No explicit policy 

STI, Sexually Transmitted Infections; HIV, HIV.

a

Parent/guardian may be informed.

Data sources for this table are found in Table 3. The information in this table may not be the most updated, accurate or complete.

We consulted Minor Consent to Medical Treatment Laws published by the National District Attorneys Association,36 Consent Laws: A Summary, third Edition13 authored by Abigail English, and additional resources specific to each state to identify relevant codes and statutes. Then we consulted the current state statutes and codes listed in Table 2 to include the most up to date consent policies. We also validated our interpretations of current laws and regulations through the following regularly updated resources: Guttmacher Institute Web site,3739  SchoolHouse Connection’s Minor Consent for Routine Medical Consent,40,VAXTEEN Consent Laws by State,41 and Kaiser Family Foundation.42 Using these resources, we were able to put together a comprehensive table of current policies regarding minor consent and privacy.

TABLE 2

Sources of Data Used for Table 1 

StateCodes and statutesAdditional sources per state
Alabama AL Code §§ 22-8-4, 22-8-5, 22-8-6, 22-8-7, 22-11A-19, 26-1-1, 26-13-1 https://www.alabamapublichealth.gov/familyplanning/assets/minor-consent-guide.pdf 
Alaska AK Stat §§ 09.55.590, 25.05.171, 25.20.010, 25.20.020, 25.20.025 http://www.touchngo.com/lglcntr/akstats/statutes/title25/chapter20/section025.htm 
Arizona AZ Rev Stat §§ 1-215, 13-1413, 36-663, 36-2024, 44-132, 44-132.01, 44-133.01 https://cdn.ymaws.com/www.azmed.org/resource/resmgr/Publications/2015_Adol_Consent_Conf_Bookl.pdf 
Arkansas AR Code §§ 9-25-101, 9-26-104, 20-9-602, 20-16-302, 20-16-304, 20-16-508 https://www.schoolhouseconnection.org/state-laws-on-minor-consent-for-routine-medical-care/ 
California CA Fam Code §§ 6922, 6924-6929 http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=FAM&sectionNum=6922. 
Colorado CO Rev Stat §§ 13-22-102, 13-22-103, 13-22-103.5, 13-22-105, 13-22-106(1), 25-4-1405(6), 27-65-103(2), 27-81-109, 27-81-110, 1008-1 https://www.coloradohealth.org/sites/default/files/documents/2017-05/Colorado_Minor_Consent_Law_Quick_Reference_Chart.pdf 
Connecticut CT Gen Stat §§ 1-1d, 19-13-D3 https://www.womenshealthct.com/media/5afpkm1n/whtr-rights-of-minors.pdf
https://www.cga.ct.gov/searchresults.asp?cx=005177121039084408563%3Ahs1zq3ague8&ie=UTF-8&cof=FORID%3A10&q=minor+consent&submission=%EF%80%82 
Delaware 13 DE Code §§ 707, 710, 16 DE Code § 2210 http://delcode.delaware.gov/title13/c007/sc01/index.html 
Florida FL Stat §§ 394.4784, 743.01, 743.015, 743.064, 743.065, 743.067 https://www.flsenate.gov/Laws/Statutes/2012/743.0645https://www.medicaleconomics.com/view/florida-consent-issues 
Georgia GA Code §§ 19-7-1, 31-17-7, 37-7-8 https://www.gaaap.org/wp-content/uploads/2012/02/minors%20access%20card%20ga%20%2008%202011.pdf 
Hawaii HI Rev Stat §§ 577D-1, 577D-2, 577A-2 https://health.hawaii.gov/camhd/files/2021/02/Minor-Mental-Health-Consent-Law.pdf 
Idaho ID Code §§ 15-1-201, 16-2403, 18-603, 32-101, 37-3102, 39-3801, 39-4503, 39-4504; 66-318 https://legislature.idaho.gov/statutesrules/idstat/ 
Illinois 77 IL Admin Code §§ 693.130, 697.20, 410 ILCS 70/5, 210/1-5 https://www.team-iha.org/files/non-gated/legal/consent-by-minors.aspx?ext=.# 
Indiana IN Code §§ 12-23-12-1, 16-21-8-3, 16-36-1-3, 16‐41‐6‐1 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Indiana-AYAH-Confidentiality-Guide_Final.pdf 
Iowa IA Code §§ 125.33, 141A.7, 147A.10, 232C.1, 599.1, 915.35 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Iowa-AYAH-Confidentiality-Guide_Final.pdf
https://idph.iowa.gov/Portals/1/Files/FamilyHealth/adolescent_law.pdf 
Kansas KS Stat §§ 38-109, 38-123, 38-2316 http://www.kslegislature.org/li_2014/b2013_14/statute/038_000_0000_chapter/038_001_0000_article/038_001_0023b_section/038_001_0023b_k/
https://codes.findlaw.com/ks/chapter-38-minors/ks-st-sect-38-2316.html 
Kentucky KY Rev Stat. §§ 214.185, 216B.400 https://codes.findlaw.com/ky/title-xviii-public-health/ky-rev-st-sect-214-185.html 
Louisiana LA Rev Stat §§ 40:1079.1, 40:1079.2, 40:1079.13 https://codes.findlaw.com/la/revised-statutes/la-rev-stat-tit-40-sect-1079-1.html 
Maine 22 ME Rev Stat §§ 1502, 1503 https://mainefamilyplanning.org/wp-content/uploads/2020/07/MFP_MinorsRights_Brochure_web-1.pdf, https://legislature.maine.gov/statutes/22/title22ch260.pdf
https://www.mainelegislature.org/legis/statutes/22/title22sec1503.html 
Maryland MD Health-Gen Code §§ 20-102 https://www.modernfamilylawfirm.com/marylands-new-law-allows-12-year-old-children-to-consent-to-mental-health-treatment/
https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&section=20-102
https://health.maryland.gov/pophealth/Documents/Local%20Health%20Department%20Billing%20Manual/PDF%20Manual/Section%20VII/MD%20Minor%20Consent%20Laws%2010%2026%2012.pdf 
Massachusetts MA Gen L ch 112, §§ 12e1/2, 12f, 123 § 10, Code of Regs 11.06, 11.08, 11.09, 11.10, 11.16, 27.06 https://www.mass.gov/info-details/guide-on-the-disclosure-of-confidential-information-health-care-information 
Michigan MI Comp L §§ 330.1707, 333.5127, 333.5133, 333.9132, 722.623 https://www.umhs-adolescenthealth.org/wp-content/uploads/2019/05/confidentiality-laws-mi-spark-handout.pdf
https://www.michigan.gov/documents/mdch/Michigan_Minor_Consent_Laws_June20093_392440_7.pdf
https://www.networkforphl.org/resources/minors-health-privacy-michigan/ 
Minnesota MN Stat §§ 144.341, 144.342, 144.343, 144.3441 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Minnesota-AYAH-Confidentiality-Guide_Final.pdf
https://www.revisor.mn.gov/statutes/cite/144.343
https://www.health.state.mn.us/people/adolescent/youth/confidential.html 
Mississippi MS CODE §§ 41-41-3, 41-41-14 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Missouri MO St. §§431.061, 431.065.1, 431.063, 595.220 https://health.mo.gov/living/families/adolescenthealth/pdf/MissouriMinorConsentLaws1-4-19.pdf 
Montana MT Code §§ 41-1-402, 53-21-112 https://leg.mt.gov/bills/2005/mca/41/1/41-1-402.htm
https://leg.mt.gov/bills/mca/title_0410/chapter_0010/part_0040/section_0050/0410-0010-0040-0050.html 
Nebraska NE Code § 71-504 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Nevada NRS §§ 129.030 129.050, 129.060 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
New Hampshire NH Rev Stat §§ 135-C:12, 141-C:18, 141-F:5, 153-A:18, 318-B:12 https://nahic.ucsf.edu/wp-content/uploads/2019/01/New-Hampshire-AYAH-Confidentiality-Guide_Final.pdf 
New Jersey NJ Rev Stat §§ 9:17A-4, 9:17A-1, 9:17B-1 https://nahic.ucsf.edu/wp-content/uploads/2019/01/New-Jersey-AYAH-Confidentiality-Guide_FINAL.pdf 
New Mexico NM Stat §§ 24-1-9, 24-1-13, 24-2B-3, 24-7A-6.2, 24-8-5, 32A-6A-15 https://nahic.ucsf.edu/wp-content/uploads/2019/01/New-Mexico-AYAH-Confidentiality-Guide_FINAL.pdf 
New York NY PHL §§ 2305, 2311, 2504, 2780(5), 2781, Ment Hygiene L § 33.21, 10 NY Comp Codes Rules and Regs § 23.4 https://www.nyclu.org/sites/default/files/thl.pdf
https://ceitraining.org/documents/AIS%20Consent%20Guide%2011%2017%2015%20FINAL%201%2011%202016.pdf
https://www.nyclu.org/en/rrp-minors-and-rape-crisis-treatment-qa
https://www.health.ny.gov/professionals/ems/pdf/99-09.pdf
https://www.health.ny.gov/professionals/ems/policy/99-09.htm 
North Carolina NC Gen Stat §§ 7B-3500, 90-21.1; 90-21.5, 90-21.9 https://www.ncleg.net/enactedlegislation/statutes/html/bysection/chapter_90/gs_90-21.5.html 
North Dakota ND Cent Code §§ 14-10-17, 14-10-19 https://casetext.com/statute/north-dakota-century-code/title-14-domestic-relations-and-persons/chapter-14-10-minors/section-14-10-19-minors-consent-for-prenatal-care-and-other-pregnancy-care-services 
Ohio OHIO REV CODE §§ 3109.01, 3701.242, 3709.241, 3719.012 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Oklahoma OK STAT §§ 43A-5-503. 63-1-532.1, 63-2601, 63-2602 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Oregon OR Rev Stat §§ 109.510, 109.610, 109.640, 109.675 https://www.oregon.gov/oha/PH/HEALTHYPEOPLEFAMILIES/YOUTH/Documents/minor-rights.pdf 
Pennsylvania PA STAT §§ 35-10101, 35-10101.1, 35-10103, 35-10104, Code §27.97 https://www.aclupa.org/en/reference-card-minors-access-confidential-health-care-pennsylvania 
Rhode Island RI GEN L §§ 14-5-4, 23-4.6-1, 23-8-1.1 https://schoolhouseconnection.org/state-laws-on-minor-consent-for-routine-medical-care/ 
South Carolina SC Code §§ 63-5-330, 63-5-340, 63-5-350 https://www.scstatehouse.gov/code/t63c005.php 
South Dakota SD CODIFIED L §§ 20-9.4-2, 25-5-24, 25-5-25, 26-1-1, 34-20A-50, 34-23-16 https://sdlegislature.gov/Statutes/Codified_Laws/2047349 
Tennessee TN Codes §§ 63-6-220, 63-6-222, 63-6-223, 68-34-107 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Texas TX Health & Safety Codes §§ 81.041, 572.001, 572.002, 773.008, TX Fam Codes §§ 32.003, 32.004 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Texas-AYAH-Confidentiality-Guide_Final.pdf
https://www.txhealthsteps.com/static/warehouse/1076-2011-Apr-20-n54e12w0v5j3bkke32k3/section_2.html# 
Utah UT CODE §§ 15-2-1, 26-6-18, 26-10-9, 62A-15-301, 78A-6-802, 78A-6-803, 78A-6-805, 78B‐3‐403, 78B‐3‐406 https://le.utah.gov/xcode/Title26/Chapter6/26-6-S18.htmlhttps://law.justia.com/codes/utah/2012/title-26/article-10/section-9 
Vermont 12 VSA §§ 7151, 18 VSA §§ 4226, 7503, 8350 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Vermont-AYAH-Confidentiality-Guide_Final.pdf 
Virginia VA CODE §§ 16.1‐331, 16.1‐333, 16.1‐334, 54.1-2969 https://law.lis.virginia.gov/vacode/54.1-2969/ 
Washington WA Rev. Code §§ 7.70.050, 9.02.100, 13.64.010, 13.64.060, 26.28.020, 70.24.110, 70.24.017, 70‐96A.095, 71.34.030, 71.34.530 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Washington-AYAH-Confidentiality-Guide_FInal.pdf
https://depts.washington.edu/uwhatc/PDF/guidelines/Recommended%20Guidelines-2017-adult.pdf 
West Virginia WV Code §§ 16-4-10, 27-4-1,60A-5-504 http://www.courtswv.gov/public-resources/guardians-treatment-of-minors.html 
Wisconsin WI Stat §§ 51.13, 51.14, 51.45, 51.47, 51.61 146.82 https://www.uwhealth.org/files/uwhealth/docs/pdf6/minors_legal_grid.pdf 
Wyoming WY Stat §§ 6-2-309, 14-1-101, 14-1-102, 14-3-402, 35-4-131 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
StateCodes and statutesAdditional sources per state
Alabama AL Code §§ 22-8-4, 22-8-5, 22-8-6, 22-8-7, 22-11A-19, 26-1-1, 26-13-1 https://www.alabamapublichealth.gov/familyplanning/assets/minor-consent-guide.pdf 
Alaska AK Stat §§ 09.55.590, 25.05.171, 25.20.010, 25.20.020, 25.20.025 http://www.touchngo.com/lglcntr/akstats/statutes/title25/chapter20/section025.htm 
Arizona AZ Rev Stat §§ 1-215, 13-1413, 36-663, 36-2024, 44-132, 44-132.01, 44-133.01 https://cdn.ymaws.com/www.azmed.org/resource/resmgr/Publications/2015_Adol_Consent_Conf_Bookl.pdf 
Arkansas AR Code §§ 9-25-101, 9-26-104, 20-9-602, 20-16-302, 20-16-304, 20-16-508 https://www.schoolhouseconnection.org/state-laws-on-minor-consent-for-routine-medical-care/ 
California CA Fam Code §§ 6922, 6924-6929 http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=FAM&sectionNum=6922. 
Colorado CO Rev Stat §§ 13-22-102, 13-22-103, 13-22-103.5, 13-22-105, 13-22-106(1), 25-4-1405(6), 27-65-103(2), 27-81-109, 27-81-110, 1008-1 https://www.coloradohealth.org/sites/default/files/documents/2017-05/Colorado_Minor_Consent_Law_Quick_Reference_Chart.pdf 
Connecticut CT Gen Stat §§ 1-1d, 19-13-D3 https://www.womenshealthct.com/media/5afpkm1n/whtr-rights-of-minors.pdf
https://www.cga.ct.gov/searchresults.asp?cx=005177121039084408563%3Ahs1zq3ague8&ie=UTF-8&cof=FORID%3A10&q=minor+consent&submission=%EF%80%82 
Delaware 13 DE Code §§ 707, 710, 16 DE Code § 2210 http://delcode.delaware.gov/title13/c007/sc01/index.html 
Florida FL Stat §§ 394.4784, 743.01, 743.015, 743.064, 743.065, 743.067 https://www.flsenate.gov/Laws/Statutes/2012/743.0645https://www.medicaleconomics.com/view/florida-consent-issues 
Georgia GA Code §§ 19-7-1, 31-17-7, 37-7-8 https://www.gaaap.org/wp-content/uploads/2012/02/minors%20access%20card%20ga%20%2008%202011.pdf 
Hawaii HI Rev Stat §§ 577D-1, 577D-2, 577A-2 https://health.hawaii.gov/camhd/files/2021/02/Minor-Mental-Health-Consent-Law.pdf 
Idaho ID Code §§ 15-1-201, 16-2403, 18-603, 32-101, 37-3102, 39-3801, 39-4503, 39-4504; 66-318 https://legislature.idaho.gov/statutesrules/idstat/ 
Illinois 77 IL Admin Code §§ 693.130, 697.20, 410 ILCS 70/5, 210/1-5 https://www.team-iha.org/files/non-gated/legal/consent-by-minors.aspx?ext=.# 
Indiana IN Code §§ 12-23-12-1, 16-21-8-3, 16-36-1-3, 16‐41‐6‐1 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Indiana-AYAH-Confidentiality-Guide_Final.pdf 
Iowa IA Code §§ 125.33, 141A.7, 147A.10, 232C.1, 599.1, 915.35 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Iowa-AYAH-Confidentiality-Guide_Final.pdf
https://idph.iowa.gov/Portals/1/Files/FamilyHealth/adolescent_law.pdf 
Kansas KS Stat §§ 38-109, 38-123, 38-2316 http://www.kslegislature.org/li_2014/b2013_14/statute/038_000_0000_chapter/038_001_0000_article/038_001_0023b_section/038_001_0023b_k/
https://codes.findlaw.com/ks/chapter-38-minors/ks-st-sect-38-2316.html 
Kentucky KY Rev Stat. §§ 214.185, 216B.400 https://codes.findlaw.com/ky/title-xviii-public-health/ky-rev-st-sect-214-185.html 
Louisiana LA Rev Stat §§ 40:1079.1, 40:1079.2, 40:1079.13 https://codes.findlaw.com/la/revised-statutes/la-rev-stat-tit-40-sect-1079-1.html 
Maine 22 ME Rev Stat §§ 1502, 1503 https://mainefamilyplanning.org/wp-content/uploads/2020/07/MFP_MinorsRights_Brochure_web-1.pdf, https://legislature.maine.gov/statutes/22/title22ch260.pdf
https://www.mainelegislature.org/legis/statutes/22/title22sec1503.html 
Maryland MD Health-Gen Code §§ 20-102 https://www.modernfamilylawfirm.com/marylands-new-law-allows-12-year-old-children-to-consent-to-mental-health-treatment/
https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&section=20-102
https://health.maryland.gov/pophealth/Documents/Local%20Health%20Department%20Billing%20Manual/PDF%20Manual/Section%20VII/MD%20Minor%20Consent%20Laws%2010%2026%2012.pdf 
Massachusetts MA Gen L ch 112, §§ 12e1/2, 12f, 123 § 10, Code of Regs 11.06, 11.08, 11.09, 11.10, 11.16, 27.06 https://www.mass.gov/info-details/guide-on-the-disclosure-of-confidential-information-health-care-information 
Michigan MI Comp L §§ 330.1707, 333.5127, 333.5133, 333.9132, 722.623 https://www.umhs-adolescenthealth.org/wp-content/uploads/2019/05/confidentiality-laws-mi-spark-handout.pdf
https://www.michigan.gov/documents/mdch/Michigan_Minor_Consent_Laws_June20093_392440_7.pdf
https://www.networkforphl.org/resources/minors-health-privacy-michigan/ 
Minnesota MN Stat §§ 144.341, 144.342, 144.343, 144.3441 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Minnesota-AYAH-Confidentiality-Guide_Final.pdf
https://www.revisor.mn.gov/statutes/cite/144.343
https://www.health.state.mn.us/people/adolescent/youth/confidential.html 
Mississippi MS CODE §§ 41-41-3, 41-41-14 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Missouri MO St. §§431.061, 431.065.1, 431.063, 595.220 https://health.mo.gov/living/families/adolescenthealth/pdf/MissouriMinorConsentLaws1-4-19.pdf 
Montana MT Code §§ 41-1-402, 53-21-112 https://leg.mt.gov/bills/2005/mca/41/1/41-1-402.htm
https://leg.mt.gov/bills/mca/title_0410/chapter_0010/part_0040/section_0050/0410-0010-0040-0050.html 
Nebraska NE Code § 71-504 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Nevada NRS §§ 129.030 129.050, 129.060 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
New Hampshire NH Rev Stat §§ 135-C:12, 141-C:18, 141-F:5, 153-A:18, 318-B:12 https://nahic.ucsf.edu/wp-content/uploads/2019/01/New-Hampshire-AYAH-Confidentiality-Guide_Final.pdf 
New Jersey NJ Rev Stat §§ 9:17A-4, 9:17A-1, 9:17B-1 https://nahic.ucsf.edu/wp-content/uploads/2019/01/New-Jersey-AYAH-Confidentiality-Guide_FINAL.pdf 
New Mexico NM Stat §§ 24-1-9, 24-1-13, 24-2B-3, 24-7A-6.2, 24-8-5, 32A-6A-15 https://nahic.ucsf.edu/wp-content/uploads/2019/01/New-Mexico-AYAH-Confidentiality-Guide_FINAL.pdf 
New York NY PHL §§ 2305, 2311, 2504, 2780(5), 2781, Ment Hygiene L § 33.21, 10 NY Comp Codes Rules and Regs § 23.4 https://www.nyclu.org/sites/default/files/thl.pdf
https://ceitraining.org/documents/AIS%20Consent%20Guide%2011%2017%2015%20FINAL%201%2011%202016.pdf
https://www.nyclu.org/en/rrp-minors-and-rape-crisis-treatment-qa
https://www.health.ny.gov/professionals/ems/pdf/99-09.pdf
https://www.health.ny.gov/professionals/ems/policy/99-09.htm 
North Carolina NC Gen Stat §§ 7B-3500, 90-21.1; 90-21.5, 90-21.9 https://www.ncleg.net/enactedlegislation/statutes/html/bysection/chapter_90/gs_90-21.5.html 
North Dakota ND Cent Code §§ 14-10-17, 14-10-19 https://casetext.com/statute/north-dakota-century-code/title-14-domestic-relations-and-persons/chapter-14-10-minors/section-14-10-19-minors-consent-for-prenatal-care-and-other-pregnancy-care-services 
Ohio OHIO REV CODE §§ 3109.01, 3701.242, 3709.241, 3719.012 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Oklahoma OK STAT §§ 43A-5-503. 63-1-532.1, 63-2601, 63-2602 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Oregon OR Rev Stat §§ 109.510, 109.610, 109.640, 109.675 https://www.oregon.gov/oha/PH/HEALTHYPEOPLEFAMILIES/YOUTH/Documents/minor-rights.pdf 
Pennsylvania PA STAT §§ 35-10101, 35-10101.1, 35-10103, 35-10104, Code §27.97 https://www.aclupa.org/en/reference-card-minors-access-confidential-health-care-pennsylvania 
Rhode Island RI GEN L §§ 14-5-4, 23-4.6-1, 23-8-1.1 https://schoolhouseconnection.org/state-laws-on-minor-consent-for-routine-medical-care/ 
South Carolina SC Code §§ 63-5-330, 63-5-340, 63-5-350 https://www.scstatehouse.gov/code/t63c005.php 
South Dakota SD CODIFIED L §§ 20-9.4-2, 25-5-24, 25-5-25, 26-1-1, 34-20A-50, 34-23-16 https://sdlegislature.gov/Statutes/Codified_Laws/2047349 
Tennessee TN Codes §§ 63-6-220, 63-6-222, 63-6-223, 68-34-107 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 
Texas TX Health & Safety Codes §§ 81.041, 572.001, 572.002, 773.008, TX Fam Codes §§ 32.003, 32.004 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Texas-AYAH-Confidentiality-Guide_Final.pdf
https://www.txhealthsteps.com/static/warehouse/1076-2011-Apr-20-n54e12w0v5j3bkke32k3/section_2.html# 
Utah UT CODE §§ 15-2-1, 26-6-18, 26-10-9, 62A-15-301, 78A-6-802, 78A-6-803, 78A-6-805, 78B‐3‐403, 78B‐3‐406 https://le.utah.gov/xcode/Title26/Chapter6/26-6-S18.htmlhttps://law.justia.com/codes/utah/2012/title-26/article-10/section-9 
Vermont 12 VSA §§ 7151, 18 VSA §§ 4226, 7503, 8350 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Vermont-AYAH-Confidentiality-Guide_Final.pdf 
Virginia VA CODE §§ 16.1‐331, 16.1‐333, 16.1‐334, 54.1-2969 https://law.lis.virginia.gov/vacode/54.1-2969/ 
Washington WA Rev. Code §§ 7.70.050, 9.02.100, 13.64.010, 13.64.060, 26.28.020, 70.24.110, 70.24.017, 70‐96A.095, 71.34.030, 71.34.530 https://nahic.ucsf.edu/wp-content/uploads/2019/01/Washington-AYAH-Confidentiality-Guide_FInal.pdf
https://depts.washington.edu/uwhatc/PDF/guidelines/Recommended%20Guidelines-2017-adult.pdf 
West Virginia WV Code §§ 16-4-10, 27-4-1,60A-5-504 http://www.courtswv.gov/public-resources/guardians-treatment-of-minors.html 
Wisconsin WI Stat §§ 51.13, 51.14, 51.45, 51.47, 51.61 146.82 https://www.uwhealth.org/files/uwhealth/docs/pdf6/minors_legal_grid.pdf 
Wyoming WY Stat §§ 6-2-309, 14-1-101, 14-1-102, 14-3-402, 35-4-131 https://ndaa.org/wp-content/uploads/Minor-Consent-to-Medical-Treatment-2.pdf 

These codes may not be the most recent versions. Immunization resources: VAXTEEN. Consent Laws by State.41 Kaiser Family Foundation. State Parental Consent Laws for COVID-19 Vaccination.42 Sensitive care resources: Guttmacher Institute, An Overview of Minor’s Consent Laws,37 Guttmacher Institute. Minor’s Access to Contraceptive Services,37 Guttmacher Institute. Minor’s Access to STI Services,39 Guttmacher Institute. An Overview of Consent to Reproductive Health Services by Young People, Guttmacher Institute. Minor’s Access to Prenatal Care.38 Additional resources on minor consent laws by state:

English, Abigail. Consent Laws: A Summary, third Edition,13 School House Connection. Minor Consent for Routine Medical Care,40 National District Attorneys Association. Minor Consent to Medical Treatment Laws.36 

Using guidelines and policy papers developed by the AAP, we explored whether evidence-based standards of care were consistent with state policies.3133,43 

Table 1 includes summary information of state laws for consent and privacy around each of the study topics (see Table 2 for sources). The regulations regarding consent for health services varied and were, at times, complex and unclear. At times, consent polices were not specified and needed to be inferred from general medical care laws. We found that limited numbers of states had explicit policies that allowed routine minor consent for the services in our table (Fig 1). There was a wide diversity in laws and regulations, with variability in the minimum age of consent, the types of minors that may consent, and the contexts within which consent is permitted. No 2 states had the same consent regulations for all the services. Parameters that influenced the ability to consent included marriage, divorce, pregnancy, minors living apart from their parents and managing their own financial affairs, incarceration, military service, treatment circumstances, services provided, and type of infections.

FIGURE 1

Health service types and numbers of states explicitly permitting universal minor consent to each.

FIGURE 1

Health service types and numbers of states explicitly permitting universal minor consent to each.

Close modal

Almost all states set the age of maturity at 18 years; however, 2 states (Alabama and Nebraska) set it at 19 years. Eighteen states allowed adolescents to consent for immunizations; however, all had specifications related to the age of the patient, status of the minor, or type of immunizations provided (Fig 2). Many states lacked a clear policy on the ability to consent for routine dental care (n = 19).

FIGURE 2

Minor consent policies for immunizations (only states with vaccination consent policies included). Hep B, hepatitis B; HPV, human papilloma virus; COVID-19, coronavirus disease 2019. San Francisco minors may consent for COVID-19; Philadelphia minors 11 and older, and able to consent, may consent for COVID-19. Data obtained from state laws listed in Table 2 and the following sources: VAXTEEN, Consent Laws by State 42, Kaiser Family Foundation, State Parental Consent Laws for COVID-19 Vaccination 43. *The information in this table may not be the most updated, accurate or complete.

FIGURE 2

Minor consent policies for immunizations (only states with vaccination consent policies included). Hep B, hepatitis B; HPV, human papilloma virus; COVID-19, coronavirus disease 2019. San Francisco minors may consent for COVID-19; Philadelphia minors 11 and older, and able to consent, may consent for COVID-19. Data obtained from state laws listed in Table 2 and the following sources: VAXTEEN, Consent Laws by State 42, Kaiser Family Foundation, State Parental Consent Laws for COVID-19 Vaccination 43. *The information in this table may not be the most updated, accurate or complete.

Close modal

Generally, sensitive health services, such as substance abuse, mental health, STI, and reproductive services, can be independently consented to by minors.13 However, we found that specifics surrounding these policies varied and, at times, were unclear. Most states allowed minors to consent for substance abuse treatment; however, 2 states left this unclear, and 15 had minimum age requirements. For mental health treatment, many states had no explicit laws for minor consent (n = 19), and the existent laws varied in the ages of consent. For sexual assault evaluations, about half had no explicit policy or did not permit minors to consent (n = 26). While all states had some provisions allowing for management of STIs, many had limitations: for example, 12 had minimum age requirements, 5 allowed minors to consent for testing only, and 1 required any positive results to be reported to the parent for patients under 12 (Fig 3). There was variability in whether STI services included HIV: slightly more than half (n = 27) allowed minors to consent for testing and treatment, while several allowed for testing alone (n = 5). For contraceptive care, almost half of the states allowed only specific categories of minors to consent (n = 24), and 4 had no explicit laws regarding consent for this type of care. Most states allowed minors to consent for prenatal care; however, 12 lacked explicit policies.

FIGURE 3

Minor consent policy constraints for STI testing and treatment.

FIGURE 3

Minor consent policy constraints for STI testing and treatment.

Close modal

In addition to variability in the ability to consent, states with laws pertaining to sensitive health care also demonstrated variability in privacy protection. Twenty states permitted providers to share information on access to STI services with the parent or guardian, 8 permitted the disclosure of information related to contraceptive services, 14 for prenatal care, 19 for substance abuse treatment, and 9 for mental health treatment.

As Table 1 demonstrates, there is substantial variability in state privacy and consent laws that govern adolescent healthcare. This variability prevents guidance on consistent high-quality adolescent health care that abides by all state consent laws and regulations. While sensitive healthcare services can generally be consented to by minors, there is variability in the details of these policies that precludes standardization of guidance. This has ramifications on the provision of care that is consistent and confidential for adolescent patients who are known to be at high-risk for sensitive medical issues. Health care that is provided in states with more restrictive consent and privacy policies may not be consistent with clinically acceptable health care standards.

State policies may differ on the ability to share sensitive health information with the parent or guardian. This creates a scenario in which an adolescent patient may consent to private, confidential care in 1 state and then cross state lines and find that this information is no longer confidential and may be shared with the parent. Inconsistency in privacy protection creates inequitable care and could result in breaches of privacy that place the patient in potentially unsafe situations. We have developed a use case to illustrate the challenges inherent in providing clinical care in the context of varying state laws and regulations (see Use Case below).

Diana is 15 years old and identifies as female. Her parents are divorced; she lives with her mother and visits her father, who has a history of domestic violence. Diana has recently become sexually active. In her home state, she may consent to confidential contraceptive care and has a pediatrician who has prescribed oral contraceptive pills (OCPs).

While visiting her father in a different state, Diana develops painful urination and realizes she has forgotten her OCPs. She tells her father she doesn’t feel well, and he takes her to the local clinic. Through an application programming interface, the electronic health information is now shared with the new EHR, including information about her OCPs. Since the laws of this state allow health care providers to disclose information to parents, the pediatrician may inform Diana’s father of her OCP use. However, the pediatrician chooses not to share this information at this time.

Diana privately discloses her symptoms and the need to refill her OCPs. The pediatrician informs Diana that she can consent to testing and treatment of an STI; however, she would need to go to a federally funded Title X clinic to consent for confidential contraceptive care. Diana is afraid to tell her father this, so she decides to forego the OCP refill, and consents to STI testing, which comes back positive.

Information about Diana’s OCP use is now accessible in her patient portal. Through a proxy account, Diana’s father learns about Diana’s OCP use and new STI medication. Information about laboratory testing is also included in the after-visit summary and the billing explanation of benefits. Diana’s father becomes very angry, and Diana is now fearful for her safety.

As seen in this use case, despite the pediatrician’s efforts to protect Diana’s privacy, the electronic information exchange system included privacy pitfalls. Differing state laws can create confusion for the patient, her family, the health care provider, EHR developers, and the medical center policy makers. Variability in privacy laws creates challenges in developing EHR systems and electronic health information (EHI) exchange that promotes the exchange of information while maintaining a priority on protecting privacy.

Complexities in the interactions among differing state laws, the Health Insurance Portability and Accountability Act (HIPAA) regulations, and the 21st Century Cures Act can provide conflicting oversight, resulting in inconsistencies in care.9,13,4447  Without clear guidance, there are compliance challenges for pediatric health care providers, EHR developers, and medical center policymakers. Increased interoperability and exchange of health information in the setting of state-by-state variability in laws creates challenges in sharing protected health information in a way that remains legally compliant. This creates a major gap in the ability to scale EHI and data exchange in a meaningful way. Since the health system is still limited by EHR technological capabilities and reliable granular filters, it can be difficult to comply with regulations while avoiding breaches of privacy. Furthermore, complexities in interpretation of conflicting regulations, challenges in legal and ethical compliance, and limited resources to navigate state-by-state variability can translate into limitations in access for patients to their health data. Medical centers that lack the bandwidth to adequately address these issues may simply block access as a necessary alternative.

The HIPAA Privacy Rule creates rights for individuals to access their own personal health information and to control access to that information. When a minor has consented to medical care, the parent does not necessarily have the right to access the personal health information related to that care. However, as we have demonstrated, some state laws permit or require disclosure of personal health information of an adolescent to a parent or guardian.13,44,45 This contradiction could lead to difficulties for providers who need to abide by state laws, even when personal health information is sensitive, and its disclosure could be emotionally upsetting or result in a risk to personal safety.

The 21st Century Cures Act has catalyzed research such as this. With this act, patients and their caregivers now have unprecedented access to EHI. However, variations in state laws may influence how successful the Cures Act is on reducing information blocking among adolescent patients and operationalizing a consistent and equitable care experience. Gaining access to health information empowers adolescent patients and improves patient care; however, harmful consequences can arise when parents or guardians inappropriately access certain personal health information.48 Appropriate implementation of the privacy exceptions in the Final Rule requires an understanding of the state and federal protection rights of the adolescents within the EHR.49 Faced with conflicting laws, health care organizations may choose to take no action, which is likely not supportive of high quality care that ensures privacy protection.

The AAP has recommended adolescent confidentiality protections through its evidence-based guidance. According to AAP policy, “Patient-provider confidentiality related to (sensitive) care is a delicate issue, especially when supporting parental involvement. If an adolescent patient is entitled to confidential care, a health care professional generally needs the adolescent’s permission to discuss her case with her parents.” According to the AAP Red Book, “Although parental involvement in adolescent health care is always desirable, consent of the adolescent should be sufficient to provide testing and treatment for HIV infection or STIs.”3133  The AAP’s commitment to protecting privacy is further demonstrated in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,33 which states that pediatricians should “receive training on how to maintain the clinical setting as a 'safe space,' particularly in terms of confidentiality.”33 This resource defines adolescence as 11 to 21 years of age and recommends that these patients be screened for STIs, making “every effort to preserve confidentiality of the adolescent.”

However, expert guidance by medical societies is bound by compliance with laws and regulations. Bright Futures specifies that, “Pediatricians should consult their own state laws for further guidance, should be aware of their state and local laws, community standards, and public health regulations, and should make use of free and confidential community-based testing programs if there are cost or confidentiality concerns.”32,43 

Medical consensus and clinical research demonstrate what the best, most health-oriented care should look like, but clinicians are potentially put into situations where laws they must abide by are in direct conflict with what is best for patients. Best practices have been established; however, state laws do not necessarily adhere to these standards. Currently, academic society guidelines refer to state laws on consent and confidentiality to maintain legal compliance. The AAP has been deliberately nonprescriptive to avoid situations where its recommendations are in direct conflict with state laws. This limits the ability to construct granular guidance that supports consistent pediatric care nationally in the context of wide-ranging state laws.

Health care providers should be able to provide guidance on how to ensure safe, secure care for all of our adolescent patients.33 According to the AAP endorsed position paper from the North American Society for Pediatric and Adolescent Gynecology and the Society for Adolescent Health and Medicine,49 there are multiple steps to protecting adolescent privacy in the setting of the Cures Act Final Rule. These include learning about state and federal laws, meeting with informatics team and legal counsel, and advocating for information access that incorporates adolescent privacy protections.16,48,49 Even with these efforts and sufficient resources, challenges in aligning the intent of state laws, federal laws, HIPAA regulations, and the 21st Century Cures Act remain.

This is a call to action to address this systemic policy issue in which state laws need to be aligned with best policies and brought closer in line with recommendations for best care. A nationwide effort to harmonize state laws would increase consistency in privacy protection for adolescents. We can’t solve these inconsistencies state by state. We must band together, determine the best policies, and promote them for the best interests of our patients.

The scope of this paper is limited to a cursory exploration into state laws. This study did not conduct a deep dive into the legal interpretations for each state but was instead an exercise meant to highlight the variability of consent and confidentiality policies inherent in state laws. Complexities in interpretation of the details of state regulations created challenges in developing a concise summary of privacy policies and may have resulted in inconsistencies in interpretations. It is possible that more recent updates in policies may have been missed.

State-to-state variability of adolescent privacy laws creates challenges for pediatric providers, EHR vendors, and policy makers, particularly in the setting of increased health information exchange. The complex interaction of differing state laws, HIPAA rules, and the 21st Century Cures Act Final Rule creates a challenging setting within which to provide safe, secure medical care for adolescents that complies with best-practice standards. Medical societies have established best practices for adolescent care through research and medical consensus; however, providers must yield to legal compliance with varying state laws. Health care providers, instead of policy makers and politicians, should be the ones determining privacy and confidentiality regulations for adolescent patients.

Drs Ancker, Rosenbloom, and Webber participated in the concept and design, provided conceptual direction, analysis, and interpretation of data, and reviewed and revised the manuscript; Dr Sharko participated in the concept and design, collected, analyzed, and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript; Ms Jameson participated in the concept and design, collected, analyzed, and interpreted the data and reviewed and revised the manuscript; Ms Krams participated in the concept and design, collected, analyzed, and interpreted the data and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: Dr Sharko is supported by the NYS Department of Health Empire Clinical Research Investigator Program. The NYS Department of Health Empire Clinical Research Investigator Program had no role in the design or conduct of this study.

COMPANION PAPER: A companion to this article can be found online at www.hosppeds.org/cgi/doi10.1542/peds.2022-056414.

     
  • HER

    electronic health record

  •  
  • EHI

    electronic health information

  •  
  • HIV

    Human Immunodeficiency Virus

  •  
  • STI

    sexually transmitted infection

  •  
  • AAP

    American Academy of Pediatrics

  •  
  • HIPAA

    Health Insurance Portability and Accountability Act

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Competing Interests

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose.