Confidentiality of medical and personal information obtained during the course of the Doula’s work is of the utmost importance to Queen B Doula Services.

 

In accordance with the privacy rule of the Health Insurance Portability Accountability Act of 1996 (HIPAA), Queen B Doula Services requires a signed release form from you, the client, before taking any notes about you or your birth or postpartum support experiences. You, the client, should keep a copy of this signed form (emailed to you after signing) for your records. Queen B Doula Services keeps the signed original in compliance with HIPAA regulations.

 

I hereby give permission for Renee' Binne to take notes about me, including personal information I choose to disclose to her, and information regarding my labor, birth and postpartum, as well as any information regarding my child/ren. I understand that this information will be shared with Renee's back up doula as needed.  In the event of an emergency, this information may be shared with medical personnel to facilitate services.

 

I also understand this information may be used for the purpose of doula certification or recertification, and for such purposes will be shared with the Certification Committee.