Social workers form part of many healthcare teams. The roles of social workers in health care can involve in-depth conversations with clients, along with home visits. These encounters can reveal a variety of sensitive information, not all of which may be known, or accessible to, other members of the healthcare team.Most modern healthcare systems employ shared care records, which are populated by, and accessible to, multiple members of the healthcare team.Shared care records are valued for their capacity to enhance inter-professional communication and, thus, improve patient care. But this very capacity may increase the underlying tension for health records between privacy and efficient and effective care. Ethical tensions can arise for health social workers between comprehensive documentation to ensure provision of appropriate and beneficial care, and protecting client privacy by limiting access to privileged information obtained in the context of a social work encounter.This qualitative empirical ethics study investigated health social workers' experiences of tensions between protecting client privacy and maintaining complete records, and how they thought the tension should be resolved. Eleven social workers from a range of health settings across New Zealand's North Island were interviewed. We adopted a pragmatist approach to ethical theory, in which everyday experiences and modes of reasoning are valid foundations for theory. Participant testimony provided the basis for developing an account of the principles that should govern decisions about recording sensitive information in shared care records. Three overarching principles were identified: necessity, accuracy, and neutrality. Participants' reports of moral concerns about some decisions regarding recording indicate that ethical tensions can occur. The identified principles offer a starting point for managing such tensions.