Notice of Privacy Practices for Lactation Consultations with Jeanette Mesite Frem, IBCLC and Associates

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED ANDHOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law designed to protect your privacy whenever your health care providers (including your lactation consultant) have to discuss your case or send information about you to different offices. We have to keep a file to record our consult, but we promise that your private, protected health information (PHI) will be kept confidential.

We can freely share all the details of your PHI for purposes of “treatment, payment and healthcare operations.” That means we can talk to you about your situation and discuss it with your other health care providers. If you are referred to other specialists, we can send the information on to them. We can also share your PHI with your health insurance company if they need it.

The law also requires us to share your PHI under other very precise situations: for example, to turnover medical records if a subpoena has been served on us or a federal agency is investigating a complaint that we have not been protecting your privacy.Any other time we share your PHI, it has to be with your specific authorization: you have to okayit first in writing. For example, you may want us to send PHI about your consultation to the HumanResources Department where you work so they can reimburse you under their workplace lactationsupport program. When you do give us permission to turn over your PHI, we can give out only theminimum amount of information needed to get the job done.

Under HIPAA, we can call or write you to remind you to come back for an appointment, or to tellyou how you can get a product or service that might interest you and your family.

You have four rights under HIPAA:

1. Access (you can ask your lactation consultant to see all the PHI she has about you);
2. Amendment (you can ask your lactation consultant to change her files to amend inaccurate
   PHI);
3. Disclosure Accounting (you can ask to whom your lactation consultant has given your PHI);
   and
4. Restriction Request (you can put limits on your lactation consultant’s use and sharing of your
   PHI).

Our duty under to HIPAA is to give you this notice so you understand we have promised to keep your PHI confidential. If we change this notice in the future, we’ll give you a new copy. Jeanette Mesite Frem, the owner of Babies in Common, is its Privacy Officer. Her phone number is 617-686-0052. We will answer your questions or concerns about how we protect the privacy of your
PHI.

You can complain if you think your privacy hasn’t been protected by your lactation consultant and we have a duty to try to patch things up. We can’t penalize you for making a complaint. If we don’t address your complaint adequately, you can go over our heads to the Office of Civil Rights of the Federal Health and Human Services (HHS) Department to ask that a formal investigation be made. You can’t go to court and sue us over a HIPAA violation, but you can ask HHS to investigate. You can get all the details from them calling (toll free) at 800-368-1019 or see their website at hhs.gov/ocr/privacyhowtofile.htm.

Copyright © Mahala Lactation and Perinatal Services, LLC (used with permission given to Jeanette Mesite Frem, IBCLC) Rev V1.0