North Carolina: minor consent, confidentiality, and custody

Who consents to treatment

A person reaches the age of majority in North Carolina at eighteen. A minor is emancipated by marriage or by a court decree, which a minor sixteen or older may petition for (G.S. 7B-3500 and following), and an emancipated minor may consent to any treatment for themselves or their child (§ 90-21.5(b)). Outside those cases, a parent or guardian consents, with the exceptions below.

Minor consent to a physician's services: G.S. 90-21.5

North Carolina's minor-consent statute is unusually broad. Under § 90-21.5(a), any minor may give effective consent to a physician for medical health services for the prevention, diagnosis, and treatment of emotional disturbance, abuse of controlled substances or alcohol, pregnancy, and reportable diseases. There is no age floor. The provider must be satisfied that the minor has decisional capacity, meaning the minor can understand the options and make an informed decision, and should document that.

Three limits apply:

• The consent runs to a physician. The statute does not by its terms authorize a psychologist, counselor, or social worker to treat on the minor's consent alone, although many practices treat services delivered under a physician's supervision as covered. Check institutional policy.
• The section does not authorize admission to a twenty-four-hour facility, except as § 122C-223 provides for an emergency.
• Under § 90-21.4(b), the physician may notify the parent of the treatment given or needed where, in the physician's judgment, that is in the minor's best interest, and the physician must notify the parent where the minor's condition endangers life or limb. Outside that, the information is confidential.

Medication is not excluded by the statute, and a physician treating emotional disturbance on a minor's consent is within the text when prescribing. In practice most prescribers involve the parent, and institutional policies usually require parental consent for psychotropic medication. Treat the minor's independent consent as a way to begin, not as a reason to keep the family out.

Inpatient treatment: G.S. 122C-221 and following

• A minor may be admitted to a facility if the minor is mentally ill or a substance abuser and in need of treatment. Except as § 90-21.5 provides, the legally responsible person, usually the parent, acts for the minor in applying for admission and consenting to treatment, and the application must be signed by that person (§ 122C-221).
• A minor may apply alone only in an emergency under § 122C-223, with notice to the legally responsible person.
• A minor admitted on a parent's application receives a district court hearing to determine whether the admission is appropriate, held within fifteen days of admission, with counsel appointed for the minor (§ 122C-224 and following). Confirm the current timing in the statute.

Involuntary commitment of a minor follows Chapter 122C and is outside the scope of this page.

What a parent is entitled to know

A parent who consents to treatment is the minor's personal representative under HIPAA and may access the record. Facility records are confidential under G.S. 122C-52 and following, with disclosure to the legally responsible person among the listed exceptions.

Two situations change that:

1. Services the minor consented to under § 90-21.5. The records of care the minor lawfully consented to are confidential from the parent unless the minor authorizes release or the physician decides to notify the parent under § 90-21.4(b), and 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.

Agree on confidentiality expectations with the family at the first visit: what will be shared, what stays between clinician and adolescent, and the safety situations in which the parent will always be involved.

Divorced or separated parents

North Carolina custody orders under G.S. 50-13.2 may award joint or sole custody and may allocate decision-making. Three practical rules follow:

• Ask for the order when the family is separated. If it gives one parent decision-making over medical care, that parent's consent is the one that counts. If it is joint or silent, 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.
• Both parents have equal access to records. Under § 50-13.2(b), absent an order of the court to the contrary, each parent has equal access to the records of the minor child involving the health, education, and welfare of the child. A parent asking you to withhold records from the other parent is not, on their own, a basis to do so. The minor-consent carve-out above applies to both parents equally.
• The minor's own consent is unaffected by the custody order.

When the minor is at risk

Duty to warn. North Carolina has no duty-to-warn statute, and in Gregory v. Kilbride (N.C. App. 2002) the Court of Appeals declined to recognize a Tarasoff-type duty to warn third parties. What the law provides is permission: G.S. 122C-55 permits a facility to disclose confidential information where there is an imminent danger to the health or safety of the client or another person, and HIPAA permits disclosure to prevent a serious and imminent threat (45 CFR 164.512(j)). The professional standard is to treat that permission as the expected practice: when a patient makes a credible threat against an identifiable person, take reasonable steps, which may include hospitalization, warning the person, and notifying police, and document the reasoning.

Mandated reporting. North Carolina's reporting duty is universal. Under G.S. 7B-301, any person or institution who has cause to suspect that a juvenile is abused, neglected, or dependent, or has died as the result of maltreatment, must report to the director of the county department of social services where the child resides or is found, orally or in writing. The duty is individual and is not satisfied by telling a supervisor. Since 2013, a person who knowingly or wantonly fails to report, or who prevents another from reporting, commits a Class 1 misdemeanor. 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.