I am a hospital and private practice RN, IBCLC.  No I don''t have or need 
physician back up, why?  You are an independent entity and can care for 
clients according to our sop.  We also are in the process to starting our outpt 
clinic.  I have NO doctors involved whatsoever.  We are just looking for office 
space.  We have a 70,000 grant.  When I do home visits, I take detailed 
history on a form that mom and I sign then I do the consult.  Payments are 
cash or check and pts decide if they want to pay for my services or not.  I 
tell them up front when they call what my hourly rate is.  MOST clients do not 
bat an eye for a home visit.  They are glad someone is available to help them.  
Insurance is not an issue for me.  In my area home visits are not covered by 
insurance.  Once they go to the clinic the grant monies will be paying for them 
to have a free consult, additional follow ups will be billed to pt.  
You are the "health care provider" and you do not need to have anyone else 
but you.  Granted you should keep careful records in case you refer someone 
to get cst or maybe a second opinion from a colleage.  You also may want to 
fax your finding to the primary pediatrician with your concerns and plan of 
care.  If you find a baby might benefit from a ENT consult maybe from a 
tongue-tie or something of this nature, the pediatrican can help the family get 
a referral.  I hope I made sense.  I am sleepy from my allergy meds and am 
getting droopy eyed.  Good luck,
robin

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