BLOOMING MOTHER LACTATION LLC
HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: September 25, 2026
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.
Blooming Mother Lactation LLC (“Blooming Mother Lactation,” “we,” “us,” or “our”) is committed to protecting the privacy of your health information.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (“PHI”), your rights regarding your PHI, and our responsibilities regarding your health information.
Blooming Mother Lactation LLC provides lactation services as a Certified Lactation Counselor (CLC). We provide services on a private-pay basis and accept HSA cards. When appropriate, we can provide patients with a superbill to submit to their insurance company for possible reimbursement. We do not submit claims directly to insurance companies on behalf of patients unless otherwise stated in a separate agreement.
This Notice applies to health information created or maintained by Blooming Mother Lactation LLC in connection with your care and services.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information.
Right to inspect and receive a copy
You have the right to inspect and obtain a copy of health information that we maintain about you, subject to certain exceptions permitted by federal and state laws.
You may request your records in paper or electronic form when available.
We may charge a reasonable, cost-based fee where permitted by law.
Right to request correction
You may ask us to correct or amend health information that you believe is inaccurate or incomplete.
We may deny your request in certain circumstances permitted by law. If we deny your request, we will provide you with a written explanation.
Right to request confidential communications
You may ask us to communicate with you in a particular way or at a particular location.
For example, you may request that we:
Contact you by telephone instead of text message.
Contact you by email.
Leave limited or no information in a voicemail.
Contact you at a particular address.
Communicate with you through a particular method.
We will accommodate reasonable requests as required by applicable law.
Right to request restrictions
You may ask us to restrict how we use or disclose your health information for treatment, payment, or health care operations.
We are not required to agree to every requested restriction.
If you pay for a health care service or item entirely out of pocket, you may request that we not disclose information about that service or item to your health plan for purposes of payment or health care operations, except when disclosure is required by law.
Right to receive an accounting of certain disclosures
You have the right to request a list of certain disclosures of your health information made by Blooming Mother Lactation LLC.
Certain disclosures are excluded from an accounting, including disclosures made for treatment, payment, health care operations, and other disclosures excluded by law.
Right to receive a copy of this Notice
You may request a paper copy of this Notice at any time.
You may also request an electronic copy when available.
Right to choose someone to act for you
If you have given someone medical power of attorney or another person is legally authorized to act on your behalf, that person may exercise your privacy rights and make decisions regarding your health information, subject to applicable law.
We may request documentation establishing that person's authority.
Right to file a complaint
You may file a complaint with Blooming Mother Lactation LLC or with the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated.
You will not be retaliated against for filing a complaint.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use or disclose your health information without your written authorization in circumstances permitted by HIPAA and applicable Pennsylvania law.
Treatment
We may use and disclose your health information to provide, coordinate, or manage your care.
For example, when permitted by law, we may communicate with a physician, midwife, nurse practitioner, pediatrician, other lactation professional, or another health care professional involved in your care.
Payment
We may use your health information to obtain payment for services we provide.
Because Blooming Mother Lactation LLC primarily operates on a private-pay basis, you may pay directly for services using accepted payment methods, including HSA cards.
When requested, we may provide you with a superbill containing information reasonably necessary for you to submit a claim to your insurance company for possible reimbursement.
Providing a superbill to you does not guarantee that your insurance company will reimburse you.
If you choose to submit your superbill to an insurance company, your insurance company may receive information contained on the superbill.
Health care operations
We may use and disclose your health information as necessary to operate our practice and provide quality services.
Examples include:
Scheduling and appointment management.
Quality improvement.
Billing and administrative activities.
Record maintenance.
Compliance activities.
Auditing.
Business planning.
Reviewing the quality of services we provide.
Appointment reminders and communications
We may use your health information to contact you regarding appointments, scheduling, follow-up care, billing, or other matters related to your care.
We may contact you using the contact information you provide, including telephone, voicemail, text message, email, postal mail, or other communication methods.
You may request that we communicate with you in a particular manner or at a particular location.
Individuals involved in your care
When permitted by law, we may disclose relevant health information to a family member, partner, support person, or another individual you identify who is involved in your care or payment for your care.
We may use our professional judgment when you are unable to communicate your preference and disclosure is appropriate and permitted by law.
Public health
We may disclose health information for public health activities when permitted or required by law.
Required by law
We may use or disclose health information when required by federal, state, or other applicable law.
Abuse, neglect, or domestic violence
We may disclose health information when required or permitted by law to report suspected abuse, neglect, or domestic violence.
Serious threats to health or safety
We may use or disclose health information when necessary to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public, when permitted by law.
Health oversight
We may disclose health information to governmental agencies for activities authorized by law, including audits, investigations, inspections, licensing activities, and other oversight activities.
Legal proceedings and law enforcement
We may disclose health information in response to a valid court order, subpoena, warrant, or other lawful process when the disclosure satisfies applicable federal and state legal requirements.
We will disclose only the information permitted or required by applicable law.
Workers' compensation
We may disclose health information as necessary to comply with workers' compensation laws and other applicable legal requirements.
Coroners and medical examiners
We may disclose health information to a coroner or medical examiner when permitted or required by law.
Research
We may use or disclose health information for research when permitted by applicable law and applicable privacy requirements.
MARKETING
We will obtain your written authorization before using or disclosing your health information for marketing when authorization is required by law.
For example, we will not use identifiable patient information to promote products or services in a manner requiring authorization without first obtaining that authorization.
You may revoke a written authorization in writing at any time, except to the extent we have already relied upon the authorization.
PHOTOGRAPHS, VIDEOS, TESTIMONIALS, AND SOCIAL MEDIA
Blooming Mother Lactation LLC will not use identifiable patient photographs, videos, testimonials, birth stories, breastfeeding or chestfeeding images, or other identifiable patient information for advertising, marketing, social media, promotional, or educational purposes when an authorization is required without first obtaining the appropriate written authorization.
A separate authorization may be required for these uses.
Choosing not to provide authorization will not affect your ability to receive care.
ELECTRONIC COMMUNICATIONS
We may communicate with you by telephone, text message, email, patient portal, or other electronic methods using contact information you provide.
Electronic communications may involve privacy and security risks.
You may request an alternative method of communication.
Please do not use ordinary email or text messaging for medical emergencies. If you have an emergency, call 911 or seek emergency medical care.
SPECIAL PROTECTION FOR CERTAIN INFORMATION
Certain types of health information may receive additional protection under federal or Pennsylvania law.
This may include, depending on the circumstances:
HIV-related information.
Genetic information.
Mental health information.
Substance use disorder treatment information.
Reproductive health information.
Other specially protected health information.
Blooming Mother Lactation LLC will comply with applicable federal and Pennsylvania laws governing specially protected information.
REPRODUCTIVE HEALTH INFORMATION
Lactation care may involve information concerning pregnancy, childbirth, postpartum care, reproductive health, and related health information.
Blooming Mother Lactation LLC will protect such information in accordance with applicable federal and state law.
SUBSTANCE USE DISORDER INFORMATION
If Blooming Mother Lactation LLC receives or maintains substance use disorder patient records that are subject to the federal confidentiality requirements of 42 U.S.C. § 290dd-2 and 42 CFR Part 2, we will comply with the applicable requirements governing those records.
MINIMUM NECESSARY USE AND DISCLOSURE
When the HIPAA Privacy Rule's minimum-necessary standard applies, Blooming Mother Lactation LLC will make reasonable efforts to limit uses, disclosures, and requests for protected health information to the minimum necessary to accomplish the intended purpose.
OUR RESPONSIBILITIES
Blooming Mother Lactation LLC is required by law to:
Maintain the privacy and security of your protected health information.
Provide you with this Notice describing our legal duties and privacy practices.
Follow the terms of the Notice currently in effect.
Notify you as required by law if a breach occurs that compromises the privacy or security of your protected health information.
Provide you with a copy of this Notice upon request.
Comply with applicable federal and state privacy requirements.
We will not use or disclose your health information other than as described in this Notice or as otherwise permitted or required by law unless you provide us with written authorization.
We reserve the right to change our privacy practices and this Notice.
If we make a material change to our privacy practices, we will make the revised Notice available as required by law.
OTHER USES AND DISCLOSURES
Other uses and disclosures of your health information that are not described in this Notice and are not otherwise permitted or required by law will be made only with your written authorization.
You may revoke an authorization in writing at any time, except to the extent Blooming Mother Lactation LLC has already relied upon the authorization.
YOUR RIGHT TO FILE A COMPLAINT
If you believe your privacy rights have been violated, you may file a complaint with Blooming Mother Lactation LLC.
Blooming Mother Lactation LLC
Privacy Contact: Kathryn Kavjian Owner/Privacy Officer
Address: 135 Scott Road
York, PA 17403
Phone: 717-912-8848
Email: hello@bloomingmotherlactation.com
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
You may submit a complaint through the HHS Office for Civil Rights.
Blooming Mother Lactation LLC will not retaliate against you for filing a complaint.
ACKNOWLEDGMENT OF RECEIPT
You will be asked to acknowledge that you received this HIPAA Notice of Privacy Practices in the Consent and Payment Agreement signed by you when you book an appointment.
Your signature acknowledges receipt of the Notice. It does not constitute authorization for uses or disclosures of your health information beyond those permitted by law.
If you decline to sign the acknowledgment, Blooming Mother Lactation LLC may still use and disclose your health information as permitted by law. We will document your refusal as required.
CONTACT INFORMATION
Blooming Mother Lactation LLC
135 Scott Road
York, PA 17403
Phone: 717-912-8848
Email: hello@bloomingmotherlactation.com
Privacy Contact: Owner/Privacy Officer
Effective Date: September 25, 2026
Last Revised: September 26, 2026