I adhere to the IBLCE Code of Professional conduct as found https://iblce.org/wp-content/uploads/2017/05/code-of-professional-conduct.pdf
Payment to be made at the time of service. All services are non-refundable. A "super-bill" will be provided for you to submit to insurance for possible reimbursement. This does not guarantee reimbursement.
New Born Families LLC does not discriminate against employees, business associates, or clients on the basis of race, color, ethnicity, national origin, ancestry, creed, citizenship status, sex, gender identity, sexuality, sexual orientation, gender expression, religion, physical ability, age, family status, or marital status.
New Born Families LLC is an inclusive practice and acknowledges that not all lactating persons identify as female or use the word mother. New Born Families seeks continuing education on cultural competency, inclusivity, racial inequities, and LGBTQIA concerns in order to provide the best possible care to all families.
Notice of Privacy Practices (HIPPA)
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
You can complain if you feel we have violated your rights by contacting us using the information on page 1. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to
200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775,
or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
• We will not retaliate against you for filing a complaint
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends, or others involved in your care, share information in a disaster relief situation, include your information in a hospital directory, contact you for fundraising efforts If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
When a phone call or email comes in from a prospective client, my policy is to do one or all of the following:
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
We can use and share your health information to run our practice, improve your care, and contact you when necessary
We can use and share your health information to bill and get payment from health plans or other entities.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
We can share health information about you for certain situations such as: Preventing disease, helping with product recalls, Reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety.
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
We can share health information about you with organ procurement organizations.
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
We can use or share health information about you: For workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, for special government functions such as military, national security, and presidential protective services.
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the Terms of This Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
I understand that during a consult for lactation support, Elizabeth Batcsics IBCLC will examine me and my breasts both visually and manually, will examine me and my baby/babies both visually and manually (including an oral exam with a gloved finger), will observe me and my baby while feeding, will make clinical observations, will provide information on techniques and breastfeeding equipment, and will make recommendations towards helping me reach my breastfeeding goals. I understand no outcome can be guaranteed.
I will provide New Born Families LLC with the names and contact information for other relevant healthcare providers for me and my baby, and New Born Families LLC may communicate with them. It is my responsibility to provide accurate information and to keep it updated. I understand that email and text are not secure means of communication, and give my permission for Elizabeth Batcsics IBCLC to send and receive texts and emails that may contain my Personal Health Information (PHI). Because New Born Families LLC will be coming to my home, I understand that Elizabeth Batcsics IBCLC will use GPS to navigate to my home.
I understand that it is my choice to have someone else present during the visit, and that anyone who sits in on the visit will have access to my healthcare information and my confidentiality may not be guaranteed. I understand that if I include any third party on an email or text with New Born Families LLC, I am granting permission for New Born Families LLC to communicate my health information and that of my baby or babies with that third party. New Born Families LLC will not initiate inclusion of any third party on an email or text. I acknowledge that New Born Families LLC is not responsible for any breach of confidentiality made by any person present I invite to be present during a visit, or added by me as a third party to text or email.
I have read and reviewed New Born Families LLC’s payment policies and understand that I am responsible for all charges associated with this visit. Elizabeth Batcsics IBCLC is providing care to me and to my baby or babies; together we are all the client of New Born Families LLC. New Born Families LLC may communicate with my insurance company in reference to the services provided to me and my baby or babies. New Born Families LLC may communicate with my credit card company or bank for any payment related matters. It is my responsibility to provide accurate and current payment and insurance information.
I give permission to New Born Families LLC to photograph or record video of me and/or my baby in furtherance of my care. These photos will not be published without my express consent, but they may be shared with my or my baby’s healthcare team.
The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. New Born Families LLC makes no representation and assumes no responsibility for the accuracy of information contained on or available through this website, and such information is subject to change without notice. All information provided on the website is general information provided for educational purposes. You are encouraged to confirm any information obtained from or through this website with other sources, and review all information regarding any medical condition or treatment with your child’s physician. Never disregard professional medical advice or delay medical treatment because of something you have read on this website.
© 2020 Annie Frisbie IBCLC, Inc, all rights reserved