Effective October 1, 2018

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.

Your Rights

You have the right to: 

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we: 

• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds

Our Uses and Disclosures

We may use and share your information as we: 

• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record 

• 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.

Ask us to correct your medical record

• 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.

Request confidential communications

• 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.

Ask us to limit what we use or share

• 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.

Get a list of those with whom we’ve shared 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.

Get a copy of this privacy notice

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.

Choose someone to act for you

• 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.

File a complaint if you feel your rights are violated

• 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.

Your Choices

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

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:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information? 

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services. 

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. 

Example: We give information about you to your health insurance plan so it will pay for your services. 

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.

Help with public health and safety issues

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

Do research

We can use or share your information for health research.

Comply with the law

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.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

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

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

• 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 website.

Self-pay clients:
If requested, we will provide you with a superbill suitable for you to submit to your insurance. The superbill (which will also serve as a payment receipt) will be coded appropriately to the level of service provided during the visit. You agree to pay me at the time of the visit (cash, check, credit card, or FSA).

If we are billing your insurance:
We will submit your fees for your insurance company's consideration. Ultimately, each client remains responsible for full payment for services. If your insurance's usual and customary allotment for each procedure satisfies your account; then you will have no remaining balance. Any remaining balances after insurance coverage are your responsibility. You are responsible for providing accurate insurance information and informing Milk Guide staff of any changes in your insurance status; if you do not have coverage at the time of your appointment, you will be responsible to pay at the self-pay rate.

Practice Better/Square Policies:
Payments may be made electronically using a credit card or fund transfer. We use Practice Better/Square to process payments. Practice Better/Square meets the high standards of HIPAA and the banking industry for security and privacy with regard to financial transactions. However, Practice Better/SquareUp may send, automatically or per your request, email or text message receipts that reveal personal health information such as the date and type of lactation visit. If you are not comfortable with this, payment may be made via cash or check instead.

We ask that you please reschedule or cancel your appointment at least 24 hours before the beginning of your appointment. By scheduling an appointment with us, we have specially blocked off that time on our calendar for you and many times that requires us arranging for and committing to child care during that time.

Cancellations within 24 hours of your appointment time will incur a cancellation fee. You may reschedule your appointment up to 12 hours before your appointment without penalty. No shows will incur a late cancellation fee.

Late cancellation fee = $50
Late reschedule fee = $40

We may consider sickness as an exclusion to the cancellation policy on a case by case basis. We will also take consideration of any family emergencies.

The International Code of Marketing of Breast Milk Substitutes (WHO Code) is found here:

HTTPS://WWW.WHO.INT/PUBLICATIONS/I/ITEM/9241541601

As a lactation provider and educator, Milk Guide upholds the principles of this policy to promote the protection of breastfeeding. Milk Guide provides education as a health care provider on the use of breast milk substitutes or artificial teats. Milk Guide does not market or sell these products. Breast pumps are not covered by the WHO Code.

Email: Communication via HIPAA compliant email is available utilizing the email address hello@milkguide.com. Email does not take the place of secure messaging, and you will have to indicate on your intake and consent forms that you wish to communicate with me via this method for discussion of your breastfeeding support.

Text/Voice Calls: Communication via HIPAA compliant text messaging is available utilizing the phone number (860) 325-2447. Text and voice calls cannot be utilized to take the place of secure messaging for discussion of your breastfeeding support needs, and you will have to indicate on your intake and consent forms that you wish to communicate with me via this method.

Video Care: Video care will be available as necessary through secure HIPAA compliant methods such as video care embedded in your Electronic Health Record accessed through your parent portal, or google meets. 

Secure Messaging: Secure Messaging is available through your parent portal as required by HIPAA laws.

Social Media: Communications through social media, including facebook messenger, are not secure. Genuine Lactation cannot utilize this method of communication for client care UNLESS the client signs the consent form acknowledging there is no way for Genuine Lactation to maintain the security of information with social media, and accepts these risks, agreeing to hold Genuine Lactation not liable.

Services rendered by Milk Guide Lactation are subject to HIPAA regulations, which requires secure payment methods by vendors willing to sign a Business Associate Agreement (BAA) in regards to management of your Personal Health Information (PHI). 

• Milk Guide Lactation processes secure payments that are HIPAA compliant via Squareup.com.