Policies and Procedures
Carly Marks is a Registered Nurse and International Board Certified Lactation Consultant (IBCLC)
Year of IBCLC certification: 2014
Next recertification date: October 2019
Recertification method : continuing education
California RN: 665665 renew 11/30/2020
Company Name: Marks Lactation Support
Husband and Wife Sole Ownership
Mailing address: 13374 Terraza Playa Cancun San Diego, CA 92124
Marks Lactation Support employs subcontractors to perform business services.
Name: Negin Atashi
Contact information: https://www.neginatashi.com/
Name: Steven Willhelm, APC
Contact Information: http://stevenhwilhelm.com/
Reviews business practices and documents (including this document)
Name: Blum and Clark
Contact Information https://www.blumandclark.com/
Files annual taxes and generates appropriate documentation
Marks Lactation Support aims to empower parents in San Diego to feed their baby their way, with up-to-date information, personalized goal-setting, and supportive strategies. We proudly support the military community.
IBLCE Code of Professional Conduct
I adhere to the IBLCE Code of Professional conduct as found here.
Marks Lactation Support does not discriminate against employees, business associates, or clients on the basis of race, ethnicity, national origin, citizenship status, sex, gender identity, sexuality, religion, physical ability, or marital status.
Marks Lactation Support is an inclusive practice and acknowledges that not all lactating persons identify as female or use the word mother.
Marks Lactation Support seeks continuing education on cultural competency, inclusivity, racial inequities, and LGBTQIA concerns in order to provide the best possible care to all families.
Policies and Procedures Review
These Policies and Procedures have been reviewed by Steven H. Willhelm, Esq.
These Policies and Procedures will be updated and reviewed by Steven Willhelm, Esq once a year February.
Client’s home: (up to 30 miles from 13374 Terraza Playa Cancun, San Diego, CA 92124)
Average Length of Initial Visit: 90-120 minutes
Average Length of Follow Up Visit:60-90 minutes
Average Length of any other visit type:60-90 minutes
Regular Business Hours: Mon-Fri 0900-1330 plus occasional evening and Saturday appointments
Marks Lactation Support provides all prospective clients with a Consent for Care. This form will be provided to the client when scheduling the visit, and must be signed before Carly Marks, BSN, RN, IBCLC travels to the client’s home. Client has the right to refuse any treatment or intervention offered, and this refusal will be documented. All attempts to continue a comprehensive visit will be made, and client will be informed of any limitations which arise from honoring Client’s refusal of treatment or intervention.
Consent is verbally requested before touching client or client’s minor child. Client may withdraw consent to be touched even if consent was previously given verbally or in writing. Withdrawal of consent will be documented.
Marks Lactation Support uses a Tanita scale to weigh the client’s baby before and after feedings. The scale will be cleaned at the beginning and end of each visit. The scale was last calibrated on 1/3/2018 by Tanita. The demo doll weighs 2lbs 9.1oz, and can be weighed at any time to confirm accuracy. If there is any question regarding scale accuracy, the batteries will be changed. If a discrepancy remains, the scale will be returned to the manufacturer.
The initial weight will be taken naked, unless client refuses.
The baby will wear a diaper, (+ clothes, if desired) while being weighed for a weighted feed, and will be wearing the same diaper (+clothes if worn during pre-weight) if a post-feed weight is taken.
Marks Lactation Support may recommend the use of certain products:
Some products may be provided (included in the fee for the visit)
Marks Lactation Support does not accept free samples
Clients will be referred to purchase items from a third party (often, but not limited to links on Amazon.com)
Marks Lactation Support is not an affiliate with any third party
Marks Lactation Support may refer clients to other professionals for continued care.
Marks Lactation Support does not accept fees for these referrals
Marks Lactation Support will provide more than one referral option
Referrals will be updated quarterly at https://www.markslactationsupport.com/resources
Client visits will be canceled in the event of provider illness or personal emergency and rescheduling is not guaranteed. In the event of cancellation for illness or personal emergency, clients will be notified by their preferred method as provided during intake.
If Marks Lactation Support is not available due to scheduling constraints, vacation, personal illness, or illness of an immediate family member :
New appointment requests will not be scheduled.
Best efforts will be made to provide the IBCLCs listed in the policy on referrals, as well as information on breastfeeding support groups in the area.
Marks Lactation Support will not respond to messages from current clients during vacation, planned closure, personal illness, or personal emergency.
Best efforts will be made to respond to messages from current clients during an illness of an immediate family member.
Marks Lactation Support is not obligated to inform clients or potential clients of unavailability due to vacation, planned closure, illness, or emergency.
Marks Lactation Support has no backup arrangement with any provider.
Best efforts will be made to notify active clients of any planned closures.
After entering Client’s home
Before touching Client or Infant
After using the bathroom
Screens and keyboards will be cleaned at the start of every visit.
Latex-free gloves are worn:
When examining an infant’s suck and oral anatomy
Fee for Service Payment Policies
Marks Lactation Support accepts payments at the time that services are provided.
All services are non-refundable.
A discount will be provided for follow up visits.
Clients are provided with a superbill with lactation services coded to S9443, 99404, or others, as applicable.
A discount is available based on the following eligibility requirements:
Referral from other provider
TriCare beneficiaries seeking care outside of the 6 visits alloted during the first year, postpartum
Initial Visit $130
Follow Up or Prenatal Discount- $30discount, with charge of $100 Unlimited number of discounted follow-up visits, for same infant.
Travel fee or cancellation fee as applicable $25
Surcharge for Travel Outside Service Area $40 per visit
Payment methods accepted
Personal Check payable to Carly Marks
Credit Card processed through PCI-compliant processor, if client signs consent for name and email sharing to:
Marks Lactation Support provides a superbills to Clients without TriCare as primary insurance, for reimbursement. Client is responsible to file claim with their insurance. Client pays at the time of service according to the payment policies above. Best efforts will be made to provide any information as required by Client’s insurance. This services is offered as a courtesy and is no guarantee of reimbursement.
Carly Marks, RN is a TriCare authorized provider for procedure code 99404. Clients must provide their Defense Benefits Number or Sponsor’s SSN, date of birth, and relationship to sponsor prior to the visit. Client’s eligibility will be confirmed via the TriWest Provider Portal, and client will be notified if eligibility is not established.
Carly Marks, RN processes the claims for Marks Lactation Support, via the TriWest Provider Portal.
Carly Marks, RN agrees to accept the TriCare negotiated rate. No Co-pay or deductible will be collected. Travel Fee or cancellation fee as applicable of $25 collected upon confirmation of appointment. Carly Marks, RN will make every effort to have this claim reprocessed by the payer. If attempts are unsuccessful and appeals are exhausted, client agrees to pay the amount in full. Carly Marks, RN will send an invoice directly to the address provided by the client.
If client’s coverage lapses, changes, or terminates prior to a scheduled visit, client is responsible to cover all charges at the self-pay rate and to inform Marks Lactation Support of this change.
If client has primary insurance through a different payer, or eligibility is not confirmed, through the TriWest provider portal, Client will pay the full self pay amount.
Carly Marks, RN/Marks Lactation Support will provide a superbill to submit to primary insurance. **If denial is forwarded to Carly Marks RN/Marks Lactation Support. Best effort will be made to bill TriCare. Once paid, client will be reimbursed the full amount paid for the visits **
If Carly Marks, RN will not be on time for a scheduled visit, Carly Marks, RN will attempt to communicate an updated arrival time by text message, or email by secondary means.
For home visits, all pets must be secure in a separate room behind a closed door or in a crate for the duration of the visit. Marks Lactation Support must be notified of any service animals who will be present prior to the visit.
Client may grant consent for others to be present during the visit. These names must be provided to Marks Lactation Support in advance and will be collected as part of the Consent for Care.
Marks Lactation Support will provide Robert Marks, MD the address for all home visits. Clients will be providing this consent prior to the visit. If Client declines to provide this consent, Marks Lactation Support will not enter into Client-Consultant relationship, and provide referrals per the above policy.
Marks Lactation Support will ask client for consent, ahead of time, for any intern, student, or assistant to attend visits.
Clinics, Classes and Support Groups
Name of group: Support Groups as Carly Marks, RN, IBCLC may substitute for colleagues, in various settings, at various times
Type of group:
Parent-to-Parent support, specific to breastfeeding/chestfeeding/pumping parents and their infant(s). It is asked that only breastfeeding/chestfeeding/pumping parents attend this group, with their infant(s). Marks Lactation Support reserves the right to recognize exceptions to these guidelines.
Facilitated group discussion
Scale for pre- and post-feed weights (refer to scale policies above)
Each Occurrence may be different
Support group is completely free, and open to parents as described, above.
Marks Lactation Support reserves the right to cancel any group offering for any reason without prior notice.
Other professionals are welcome to attend group offerings, with advanced,notice and for observational purposes only. They are requested not to participate. They may not offer marketing items to group participants.
Disclaimer: Breastfeeding Support Groups facilitated by Marks Lactation Support is
Parent-to-Parent support, specific to lactating parents and their infant(s). A scale is available for participant’s use. It is participant’s choice to record information on the group sign-in. Conversation regarding all things breastfeeding and parenting is shared, in confidence, and it is expected that participants respect each other’s confidentiality. Although Facilitator will apply their knowledge of breastfeeding when speaking with participants, these interactions cannot replace Lactation Consultations, and, as such, advice gained through the support group activity should not be relied upon other than as general advice. Each parent and child clients have their own idiosyncratic
issues which can only be truly tailored to each client group through one on one Lactation Consultations.
Marks Lactation Support does not offer telemedicine.
Choose all that apply:
Marks Lactation Support schedules existing clients through ChARMhealth, often having agreed upon the date and time on phone, text, email, website contact feature.
Marks Lactation Support offers online scheduling through ChARMhealth, embedded in https://www.markslactationsupport.com/book-online
Appointments for prospective clients will only be taken through online scheduling. Availability may be discussed via phone, text, email or website contact feature,
Marks Lactation Support reserves the right to reschedule or cancel appointments for any reason.
Priority scheduling will be given to established clients.
Priority scheduling will be given to Tricare clients.
Prospective clients may not schedule visits more than 7 days in advance, without further communication with Carly Marks, RN, IBCLC.
An appointment confirmation, and reminder will be sent
If client cancels the visit for any reason less than 4 hours in advance, no fee will apply. Marks Lactation Support reserves the right to refuse to reschedule the visit.
If Marks Lactation Support must cancel an appointment for any reason, no charges to the client will apply. Marks Lactation Support reserves the right to cancel appointments for any reason without notice.
Phone, Email, and Text Services
Marks Lactation Support maintains a website at https://www.markslactationsupport.com hosted by Wix. Contact phone number and email address are publicly posted. Website has a contact form that accepts submissions; data from this contact form is stored.
When a phone call, email, and/or text comes in from a prospective client comes in, the policy is to:
Send a text message or email reply within 48 hours
Send a link to my online scheduler
Send a link to my website for more information on my services
Marks Lactation Support does not provide clinical support or counseling to prospective clients
Clients receive 2 weeks of follow up support by email and/or secure messaging as part of their fee for services, to include services paid via insurance.
Marks Lactation Support provides secure messaging to established clients through
Encrypted and secure email via Gsuite, preferred method of Marks Lactation Support
ChARMhealth patient portal is an option, if Client uses the portal for messaging, Marks Lactation Support will reply in-kind, and continue communication only through ChARMhealth patient portal.
Secure messages will be replied to
Within 24 hours
During business hours
Follow-Up Communication regarding each visit
Will be sent within 24 hours
Client will receive the same report sent to providers, and notified to whom the report will be sent. The email will include references, referrals, and other information discussed during the visit.
Report will be sent to Infant’s provider for every visit, unless documented otherwise
Report will be sent to Client’s provider, if there is anything remarkable to report on Client, or at Client’s request
Report will be sent to any HIPAA-covered entity, upon Client’s request. Client will be notified.
Marks Lactation Support plans to send periodic marketing emails through (a service to be determined). Clients are required to give express consent before being added to an email marketing list. Clients may request to be removed from the list at any point by (sending an email request, clicking a link in the email). Marks Lactation Support will never sell or rent this marketing list.
Social Media Communications
Carly Marks or Members of Marks Lactation Support may maintain private social media accounts for personal use. Connection or direct message requests made by clients or prospective clients through these platforms will not be accepted.
Marks Lactation Support maintains public social media accounts for marketing purposes on the following platforms: Facebook, Instagram, WIX website. All photos appear by express permission of the owner of the photo and all persons appearing in the photo. No client photos or videos will be published without express written consent. Clients and/or their minor children will not be named in posts on social media without express written consent.
Marks Lactation Support will not provide direct clinical support or counseling or advice on any social media platform, either public or private. Public accounts are for marketing purposes only, to offer general information.
Social Media Policies for Marks Lactation Support are posted on all public social media channels.
Website Terms and Conditions are publicly posted on the website for Marks Lactation Support.
HIPAA Notice of Privacy Practices is publicly posted on the website for Marks Lactation Support.
Contact form entries via the website are stored
In the Wix platform
Prospective Client may request an appointment via ChARMhealth
Client to IBCLC relationship is established upon signature of Consent for care, Privacy and Payment policies
Client’s email is stored in Gsuite platform with appropriate security & privacy measures
Marks Lactation Support abides by all federal, provincial, state, and local regulations regarding copyright. No text, image, or graphic content will appear without the express permission of the copyright or trademark holder.
Record Retention Policies
Marks Lactation Support is subject to the record retention laws of CA, and is required to keep client records until 21 years after an in-person visit. Records include email correspondence, and Electronic Health Record.
Clients may request a copy of their chart or that of their minor child at any point during the record retention period. Request must be made in writing to the listed address for Marks Lactation Support. Receipt of the request will be acknowledged by Marks Lactation Support and records will be mailed within 30 days of acknowledgement of the request.
Marks Lactation Support provides records for free within 6 months of the last in-person visit; after this period, a fee of $25 will be charged and must be paid in advance.
Client files are digital, but paper charting is back-up, in the case of technological failure
Physical records are scanned as soon as possible, and entered into Client’s file, then shredded before disposal.
Compliance with Privacy Regulations
Marks Lactation Support is in compliance with all applicable federal and provincial/state regulations with respect to the use of technology for healthcare.
Notice of Privacy Practices is publicly posted on the website for Marks Lactation Support.
All devices used for client care will be secured by a passcode and/or biometric identification.
The following person has access to the passcode in case of emergency Robert Marks, MD.
Marks Lactation Support uses ChARMhealth for client care. The following safeguards are in place:
Marks Lactation Support will not use any free cloud-based services for client communication or file storage.
Email services and document storage are provided through:
G-Suite, with a Business Associates Agreement for HIPAA compliance
Phone services are provided through:
Website Terms and Conditions are posted publicly on the website https://www.markslactationsupport.com
Carly Marks, BSN, RN, IBCLC is unable to receive vaccinations.
Carly Marks, BSN, RN, IBCLC actively pursues continuing education related to lactation management, infant and child development, parental wellness, communication skills and cultural competence.
Carly Marks BSN, RN, IBCLC is a mandatory reporter for signs of child abuse or neglect, elderly abuse, and domestic violence. This does not include investigation or confirmation. She will call County Social Services Department's Child Protective Services Child Abuse Hotline at (858) 560-2191 or (800) 344-6000, according to guidelines provided.
Marks Lactation Support accepts gifts from clients when services are concluded.
If applicable, gifts may be donated to San Diego Breastfeeding Center Foundation, or The Wounded Warrior Project.
Marks Lactation Support refuses or destroys any and all donations, gifts, samples, or services from any company or subsidiary company not in compliance with the WHO Code of the Marketing of Breastmilk Substitutes.
The policy of Marks Lactation Support is to purchase all necessary supplies at retail and/or wholesale if appropriate.
For home visits:
I have a policy to accept offers of water from clients.
I will remove my shoes.
I will never request to use the bathroom in a client’s home.