Table 1.

Hypothetical scenarios for potential harm related to either lack of clarity of the laws, technical limitations regarding the release of electronic health information, or a combination of both.

At risk for harm	Third party receiving information	Domain	Mode of disclosure	Consequence
Patient	Parents or guardian	Mental health	Patient portal	Avoiding care or deterioration
Patient	Parents or guardian	Substance use	Patient portal	Avoiding care, overdose, or continued addiction
Patient	Parents or guardian	Sexual history or reproductive health	Patient portal	Avoiding care, complications from sexually transmitted infection, or infertility
Patient	Parents or guardian	Gender management or identity	Patient portal	Avoiding care, delay in gender reassignment, or psychological impact
Patient	Parents, guardian, or abuser	Violence or abuse (physical or sexual)	Patient portal	Avoiding care, continued abuse, complications, or death
Patient	Parents or guardian	Complex social situations	Patient portal	Avoiding care or delayed care
Patient	Parents or guardian	Neglect	Patient portal	Avoiding care, delayed care. or continued neglect
Child/Adolescent	Parents or guardian	Foster or custody issues	Patient portal	Avoiding care, delayed care, or family strife
Child/Adolescent	Parents or guardian	Misattributed paternity	Patient portal	Avoiding care, delayed care, or family strife
Parent/Care Giver / Legal Guardian	Patient, other parent, or other care giver	Perinatally acquired sexually transmitted infection	Patient portal	Avoiding care, delayed care, or family strife
Parent/Care Giver / Legal Guardian	Patient, other parent, or other care giver	Substance abuse	Patient portal	Avoiding care, delayed care, or family strife
Parent/Care Giver / Legal Guardian	Patient, other parent, or other care giver	Parent or caregiver’s mental health	Patient portal	Avoiding care, delayed care, or family strife
Parent/Care Giver / Legal Guardian	Patient, other parent, or other care giver	Violence, abuse, or legal problems	Patient portal	Avoiding care, delayed care, or family strife
Parent/Care Giver / Legal Guardian	Patient, other parent, or other care giver	Misattributed paternity	Patient portal	Avoiding care, delayed care, or family strife
Parent/Care Giver / Legal Guardian	Patient, other parent, or other care giver	Stress associated with chronic care	Patient portal	Family strife or mistrust
Provider	Patient, other parent, or other care giver	Patient or family disagreement with provider	Patient portal	Delayed or missing documentation
Provider	Patient, other parent, or other care giver	Neglect or abuse	Patient portal	Lawsuit or unsafe environment for the provider