HIPPA NOTICE OF PRIVACY PRACTICE

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.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law designed to

protect your privacy whenever your health care providers, like the International Board Certified

Lactation Consultant (IBCLC), have to discuss your case, or send information about you to different

offices. Gracefully Grown Lactation and More, LLC is required to keep a file to record our consult, but the private, protected health information (PHI) in it will be kept confidential. IBCLCs can freely share all the details of your personal health information for purposes of “treatment, payment and health care operations.” That means the IBCLC can talk to you about your situation and discuss it with your other health care providers. If you are referred to other specialists, the IBCLC can send the information on to them. The IBCLC can also share information with your health insurance company if they need it. The law also requires Gracefully Grown Lactation and More, LLC to share your information under other, very precise situations: for example, if a subpoena has been served on this office to turn over medical records or a federal agency is investigating a complaint that we have not been protecting your privacy. Any other time the IBCLC or Gracefully Grown Lactation and More, LLC shares your personal health information it must be with your specific, written authorization first. For example, you may want Gracefully Grown Lactation and More, LLC to send information about your consultation to the Human Resources Dept., at your place of employment so they can pay you back under their corporate lactation support program. When you give Gracefully Grown Lactation and More, LLC permission to turn over information about you, we can give out only the minimum amount of information needed to get the job done.

In the event that there are other instances where the IBCLC may wish to share your information, you will

be asked to consent to each instance separately, and you may choose not to consent to any or all of this

additional sharing. Under HIPAA, the IBCLC can call or write you to remind you to come back for an

appointment or to tell you 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 the IBCLC to see all of your protected health information (PHI) on file

2. Amendment: you can ask the IBCLC to change her files to amend inaccurate PHI

3. Disclosure Accounting: you can ask to whom the IBCLC has given your PHI

4. Restriction Request: you can put limits on the IBCLCʼs use and sharing of your PHI