Micki:  Yes, you always have to have a signed health care consent.  One of 
the perks of being hospital-based is that the hospital has a nice multi-
copy printed consent form that the mom signs when she comes in to deliver.  
This covers all the care, including lactation, that she receives as an 
inpatient.  If I see a mom or baby as an outpatient in the office, I have 
her sign another consent for either herself or her baby, depending on if 
it's a mom or baby issue.  And you always send a report to the appropriate 
physican.  This serves several purposes - it keeps the doc in the loop.  It 
helps with consistency and continuity and becomes a part of the chart in 
the doc's office, so that even his office nurses are able to see what the 
lactation recommendations are and help to review/reinforce this 
information. And it is the right (legal) thing to do.  I fax my reports to 
the doc.
The doctor's order (I operate on standing orders), copies of the mom's 
driver's license/insurance card, and a copy of the signed consent go down 
to medical records to be added to the mom's or baby's chart so that the 
hospital also has a permanent record that she has been seen at the hospital 
as an outpatient.  And, yes, my outpatient consults are covered by 
insurance, which is why I have a standing doctor's order - nurses currently 
are not 3rd party reimbursable, at least in my state.  I also keep a hard 
copy of the chart in my office.


Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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