Consent/ GDPR information:
I give my consent for Alice, IBCLC to work with myself and my baby during this consultation. This consent covers home visits, phone calls, video calls and emails/ messages sent, and includes all follow-up.
I understand that any consultation with Alice may involve:
- Touching my breasts/ nipples for the purposes of assessment
- Inserting gloved fingers into my baby’s mouth to assess suck
- Observation of a breastfeed, and suggestions to enhance latch/ positioning
- Demonstration of equipment, supplies and techniques
I understand that it is my responsibility to call Alice with progress reports, questions or concerns
I give my consent for Alice to release any information acquired in the evaluation and/or management of myself/my child to our healthcare providers. I understand that Alice may contact my/my child’s GP if she feels it is necessary.
I give my consent for Alice to use clinical information obtained during our consultations for the use of educating other healthcare providers and/or mothers about lactation. I won’t be identified in any way, but some aspects of my situation may be described and discussed
I understand that payment in full is expected at the end of the consultation.
I understand that for this consultation and all follow up, Alice will protect the privacy of my personal health information as required by the Code of Ethics of the International Board of Lactation Consultant Examiners, the Standards of Practice of the International Lactation Consultant Association.
In accordance with GDPR 2018 you must be informed what data will be requested from you, how that data will be processed or shared, and what your rights are in relation to that data. I will only request information that I need in order to provide my services effectively and safely. I will retain your consultation data for a period of 25 years as per Government requirements. Your information will not be used for marketing purposes. The data held will contain your name, age, address, email, your child's name and date of birth, medical history, consultation notes, and may include a baby's weight chart, care plan and a report to your GP. Information may be shared with your health professionals (see above). You have the right to request access to your personal data. You also have the right to correction and deletion of that data (where appropriate). If you are not happy with how your data is managed, you have the right to complain. I reserve the right to contact you in the future regarding other services.