How to Sign Up for Proxy Access

Proxy access is the process by which parents, legal guardians or those caring for patients with diminished decision-making capabilities may gain access to a patient’s health record via the patient portal.

Yes, without any legal supporting paperwork, proxy access to the current health information will only be granted to parents of children through age 11.

Legal guardians of children 11 years old and younger may submit court-appointed guardianship papers when requesting access.

For anyone requesting access to the current health information of a patient 12 years of age and older, legal documentation that demonstrates a right to access that information, such as durable power of attorney or documentation of legal guardianship, may be submitted when requesting access. This includes requests from adults who are caring for other adults, i.e. elderly parents.

Confidentiality protections and consent requirements for minors are closely linked. There are certain types of care that minors can consent for on their own and can expect confidentiality protection from their parents. Examples include testing for sexually transmitted infections and voluntary substance abuse treatment. Offering confidential care is key to encouraging young people to seek necessary care on a timely basis and to provide a candid and complete health history when they do so. Shenandoah Medical Center (“SMC”) has determined that this protection is appropriate starting when minors reach the age of 12.

Although the types of services minors can consent to on their own and have confidentiality protections from their parents is limited, SMC’s patient portal does not have the capability, at this time, to segregate information relating to those services. Under our system, all patient visits are available in the patient portal and viewable by a proxy.  In order to comply with Iowa law allowing minors to consent to certain care on their own and have confidentiality protections for those services, we are restricting parent proxy access when the child turns 12. Once a child turns 12 SMC is only able to offer proxy access to parents and legal guardians of patients in this age group when the proper legal documentation is presented. This functionality may change in the future, and at that time SMC portal users will be notified of the enhanced capabilities.

If the requestor already has access, the child’s chart will be ‘frozen’ upon the 12^th birthday. This means that no new data will flow to the portal; however, records created prior to the birthday will still be accessible. In addition, the requestor will continue to be able to create messages via the portal functionality and can message only those providers related to encounters prior to the 12^th birthday.

The child’s record will continue to be frozen, just as it occurred at the age of 12. No new data will flow to the portal; however, records created prior to the 12^th birthday will still be accessible. In addition, the requestor will no longer be able to create messages via the portal functionality. Upon the 18^th birthday, the patient would also be eligible to request their own access to the portal.

The age of majority in Iowa is 18; young adults age 18 or older can consent for their own health care and therefore the need for parental oversight ceases unless the patient is impaired and unable to give informed consent.

Portal users may request access for those with impaired decision making. Durable power of attorney documentation is required if the patient is 12 years or older. Parent(s) of patients 11 and under will be allowed to access the child’s patient portal  without legal documentation. Legal guardians of patients 11 and under will need to submit documentation in the form of the court appointment of the legal guardian and the letter of legal guardianship.

Under the law, it is only the parent(s) and/or legal guardian(s) who are authorized to access minor patients’ medical records. The form may be completed by the Mother, Father, DPOA, or Legal Guardian only. If a Stepparent has completed the adoption of the child, the law provides for them to be able to mark the Mother or Father relation to patient. On the form there will be an asterisk next to legal guardian that indicates legal guardians need to submit copies of documents establishing legal guardianship to the clinic. Generally, these are the court appointment of the legal guardian and the letter of legal guardianship. If the patient brings originals to the clinic, we will copy them and maintain the copy in the patient’s record. From a legal standpoint, if a stepparent does seek access to the portal for their minor stepchild, we are legally required to obtain the written consent of both parents/legal guardians to permit this access, and the authorization would need to be documented on a HIPAA-compliant authorization form that would include a description of “access to electronic patient portal records” or something similar in the description line.

After the compliance officer, or designee, has completed the review process and marked the form as approved or denied, it should be scanned into the HIPAA/Legal folder in Allscripts. Please refer to the process documents for a complete set of steps involved in the approval process.

Yes, parents can still request a copy of their minor child’s medical records (until the child turns 18) from Shenandoah Medical Center by contacting the office. Parents will be able to view all medical services received by the child unless it is a service that does not require parental consent under Iowa law, including family planning services (minors age 12 or older who meet financial and other eligibility requirements), sexually transmitted infection (STI) testing and treatment, HIV testing (unless test is positive), voluntary substance abuse treatment or rehabilitation, and medical or mental health services for sexual assault, unlawful sexual conduct, or sexual abuse without prior parental knowledge.  As discussed above, the law allows minors to receive these services without parental consent and therefore, these records are confidential, even from the minor’s parents.