I'm willing to bet I am the only person on Lactnet who has read every single 
word of the federal regulations that comprise HIPAA.   So it is with no 
small amount of hubris that I condense it for you as follows:

(1)  HIPAA was orginally designed to streamline paperwork and processing of 
health insurance in the USA.  Privacy protections are just one part of it.

(2)  HIPAA prevents a health care practitioner (HCP) from disclosing 
(talking about) a mother's PHI unless it is *permitted* or *required* by the 
regulation, OR the mom gives her written permission to do so.

(3)  Every "covered entity" must have a "notice of privacy practices" that 
it gives to the mother.  The infamous form she is signing is mom's 
acknowledgement that she received the notice of privacy practices.

(4)  "Covered entities" are a health plan ... a health care clearinghouse 
... or a health care provider (like IBCLCs) who furnish, bill, or are paid 
for providing health care, incl. the sending of an "encounter form"

(5)  WIC is a bit wobbly on this point:  it depends on how the WIC office is 
set up.  If it serves as a clinic, it falls under HIPAA.  If it merely 
offers information about nutrition, it is not providing "health care"

(6)  HIPAA has a huge loophole (so big I call it a pothole) which allows any 
healthcare provider to discuss with any other healthcare provider whatever 
they want about Mom, if the discussion involves "treatment, payment or 
health care operations" involving the Mom's case.   And they don't have to 
get her permission first.

Sounds whacky, but it makes some sense when you look at it this way:  health 
care practitioners need to have full and unfettered access to information 
about a patient in order to make the time-sensitive recommendations or 
decisions that are inherent to quality health care.  The physical therapist 
needs to know about the surgery done on the knee, and the knee surgeon needs 
to know about the allergy to certain foods and medicines, and the dietitian 
needs to know about the patient's history of obesity ....

(7)  Mom is certainly within her rights to restrict the sharing of 
information with people who are OUT of the health-care loop.  Her boss 
doesn't need to know that she is allergic to certain meds, or that she is 
considered obese, but he probably does have the right to know that knee 
surgery took place (so he can authorize insurance coverage, for example, and 
permit sick leave during recuperation).  And the man-in-the-street doesn't 
need to know any of this stuff, which is why we are all running aroung 
covering up our charts and computer screens ....



Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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