Arizona: minor consent, confidentiality, and custody

Who consents to treatment

A person reaches the age of majority in Arizona at eighteen. Under A.R.S. § 44-132, an emancipated minor, a married minor, and a homeless minor may consent to their own hospital, medical, and surgical care, and a minor sixteen or older may petition for emancipation (§ 12-2451 and following). § 44-133 allows emergency treatment without consent where a parent cannot be reached. Outside those cases, a parent or guardian consents, and for mental health care Arizona says so expressly.

Mental health treatment requires a parent: A.R.S. § 36-2272

Arizona is one of the few states with a statute that forbids treating a minor without a parent. Under § 36-2272(A), except as otherwise provided by law or a court order, no person, organization, or institution may perform mental health screening in a nonclinical setting or mental health treatment on a minor without first obtaining the written or oral consent of a parent or a legal custodian. § 36-2272(B) excepts an emergency where treatment is needed to prevent serious injury or save the minor's life. § 36-2272(C) makes a violation a class 1 misdemeanor. The statute sits alongside Arizona's parents' rights act (§ 1-602), which lists the right to consent to a minor's mental health treatment among the fundamental rights of parents.

So in Arizona there is no outpatient window, no session limit, and no mature-minor route. A clinician who treats a minor's mental health condition obtains a parent's consent first, and documents it, unless an emergency, a court order, or the emancipation and homeless-minor provisions above apply. Medication follows the same rule.

Drug and alcohol treatment: A.R.S. § 44-133.01

The one minor-consent provision touching substance use is narrow. A minor twelve or older who is diagnosed by a physician as under the influence of a dangerous drug or narcotic, including withdrawal symptoms, is deemed to have consented to hospital or medical care related to that condition, and parental consent is not required for it. That covers acute treatment; ongoing substance use treatment for a minor proceeds on a parent's consent. Records of a program that meets the federal definition are also subject to 42 CFR Part 2.

Inpatient treatment: A.R.S. § 36-518

A parent, guardian, or custodian may apply in writing for the voluntary admission of a minor to a mental health agency, and consents to treatment on the minor's behalf. A minor who is a ward of the court or in the custody of the juvenile court requires court approval except in an emergency. Court-ordered evaluation and treatment follow Title 36, Chapter 5 and are outside the scope of this page.

What a parent is entitled to know

Because the parent consents to treatment, the parent is the minor's personal representative under HIPAA and may access the record, and § 1-602 lists access to the minor's medical records among parents' rights. Arizona's medical records statute (§ 12-2293) and the mental health confidentiality statute (§ 36-509) govern access and disclosure; a provider may withhold part of a record where disclosure could reasonably be expected to endanger the patient or another person, with the reasons documented.

Two situations change the picture:

1. Care the minor consented to under § 44-132 or § 44-133.01. Where the minor lawfully consented and no parental consent was required, HIPAA treats the minor as the person who controls the protected health information for that care (45 CFR 164.502(g)(3)).
2. Psychotherapy notes kept separately have their own protection under HIPAA regardless of who consented.

Outside those situations, Arizona does not give adolescents a right to confidentiality from parents, and the parents' rights act makes the point explicitly. What a clinician can do is agree with the family at the first visit on what will be shared, what stays between clinician and adolescent as a matter of the parent's choice, and the safety situations in which the parent will always be involved.

Divorced or separated parents

Arizona replaced "custody" with legal decision-making in 2013. A court awards sole or joint legal decision-making, meaning the right and responsibility to make non-emergency decisions including education, health care, religious training, and personal care (A.R.S. § 25-401), and a parenting plan sets parenting time. Three practical rules follow:

• Ask for the order when the family is separated. If one parent has sole legal decision-making, that parent's consent is the one that counts. Under joint legal decision-making, either parent can ordinarily consent to routine treatment, but a major decision one parent opposes is a dispute for the parents, and if necessary the court, to resolve. Pause non-urgent treatment, document what each parent was told, and do not pick a side.
• A parent without legal decision-making keeps access to records. Under § 25-403.06, unless the court finds that it would endanger the child's health or safety, both parents are entitled to have equal access to documents and other information concerning the child's education and physical, mental, moral, and emotional health, directly from the provider, and a parent who withholds that information from the other may be sanctioned.
• The minor's own consent is not a factor in Arizona, since the parent consents to mental health treatment in any case.

When the minor is at risk

Duty to warn. Arizona's duty is statutory. Under A.R.S. § 36-517.02, a mental health provider has a duty to take reasonable precautions when a patient has communicated an explicit threat of imminent serious physical harm or death to a clearly identified or identifiable victim or victims and the patient has the apparent intent and ability to carry out the threat. The duty is discharged by communicating the threat to the victim, notifying a law enforcement agency in the vicinity of the patient or the victim, taking reasonable steps to initiate hospitalization, or, for a patient who is a minor, notifying the parent or guardian. No duty arises outside those circumstances, and no liability attaches for a good-faith disclosure made to discharge it. Document the threat, the assessment, and the steps taken.

Mandated reporting. Under A.R.S. § 13-3620, physicians, psychologists, behavioral health professionals, nurses, school personnel, and the other listed persons who reasonably believe that a minor is or has been the victim of physical injury, abuse, neglect, or a reportable offense must immediately report, or cause a report to be made, to the Department of Child Safety hotline at 1-888-767-2445 (1-888-SOS-CHILD) or to a peace officer. A written report follows within seventy-two hours. The duty is individual. Failure to report is a class 1 misdemeanor, and a class 6 felony where the unreported matter is a reportable offense; good-faith reporters are immune.

Hospitalization. See the inpatient section above.

School records

A school's records about a student, including records from a school counselor or school-based clinician employed by the district, are governed by FERPA rather than HIPAA, and parents have rights of access under FERPA until the student turns eighteen. Records a school receives from an outside clinician become part of the education record once filed. Send the school what it needs to act, not the full evaluation.