Newly Revised
June 2006
Now Complete Packet is Available on CD
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Creating
Professional
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The Lactation Visit Receipt Packet
The LVR Packet is INTENDED for use by IBCLCs, doctors, nurse practitioners or other health care providers.
International Board Certified Lactation Consultant ( IBCLC ) is the Gold Standard in lactation consulting.
A note from Pat: I began my research into 3rd Party Reimbursement to design a superbill to meet my practice needs, I did a survey of about 30 LCs (most in private practice) to see what they thought was important in a lactation superbill. While doing the survey, there was so much interest in a new superbill with up-to-date coding that I was urged to make it available to others. This resulted in the Lactation Visit Receipt Packet. The LVR Packet has been reviewed by many of my peers and can be found in Linda Smith's book “ The Lactation Consultant in Private Practice: The ABCs of Getting Started”, in Breastfeeding and Human Lactation, 3rd Edition, Jan Riordan, in ILCA's " Reimbursement Tool Kit" by Marsha Walker and in Medela's Messenger issue 20.1, 2003.
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A major revision of the Lactation Visit Receipt Packet was completed on June 10, 2006. It can be Ordered On-line or order by
Mail In Order Form
(PDF). The complete packet is now available on CD-R or it can be attached e-mailed in a zip file. The actual Lactation Visit Receipt is in a pdf so as many or as few copies as needed can be printed. You may want to print it out and take it to a printer such as Office Depot, Office Max or Staples for printing (the LVR is recommended to be printed in triplicate).
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The LVR Packet includes the following:
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Customized Header on the 2006 version of Lactation Visit Receipt in PDF
Sample LVR

A 18 page instruction booklet with details on filling out the LVR & basic reimbursement information in PDF
BONUS FORMS - Templates of the following in WORD:
Breastfeeding Questionnaire / Medical History Form
SAMPLE
Consent / Financial Form
SAMPLE
Pump Rental Contract Form
SAMPLE
HIPAA Privacy Practices Form
SAMPLE
HIPAA Compliant FAX Form
SAMPLE
Referral for Lactation Visit Form
SAMPLE
AND, more
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NEW REQUIREMENT FOR Healthcare providers to have a National Provider Identifier by
I am now recommending superbill have both a EIN and a NPI number on it.
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Endorsements of LVR.....
At ILCA 2002 Conference, Marsha Walker called the LVR Packet, a "fabulous reimbursement packet."
Voted in the top 5 Best Business Investments by 2003 Private Practice Lactation Consultant Conference
"Pat Lindsey's superbill is excellent !!!! ( thank you Pat ) and It is working. I am working part-time for a Family Practice doctor who does OB. I use Pat's superbill and fax it to this docs biller. It does take me 1-2 months to get payment, however. Pat's superbill has been one of my best investments as a professional Lactation Consultant." Star Siegfried,RN,BA,IBCLC 1 June 2002
"thank you so much for the superbill and forms. They are gold. : )" Diana West, IBCLC
Copies of LVR can be found in the following books:
ILCA's Reimbursement Tool Kit for Lactation Consultants by Marsha Walker
Breastfeeding and Human Lactation, Third Edition, page 54, by Jan Riordan
The Lactation Consultant in Private Practice: the ABC's of Getting Started, page 326, by Linda Smith
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Three Ways to Order the LVR
Please be sure to list out what you wish to appear as your header on the LVR (superbill) when placing your order. You will get a confirmation e-mail from Pat with estimated time to receive your packet. Orders can usually be fill in 7-10 days unless Pat is out of town. Your header information should read something like this:
Lactation Services
Pat Lindsey, IBCLC
Registered Board Certified Lactation Consultant
P.O. Box 9999, Anytown, FL 09999 - Phone 1-888-900-0000
NPI # 1234909876 Tax ID # 59-999999
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Complete
Lactation Visit Receipt Packet
on CD-R
$50.00
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Two Upgrade Options for Previous Customers who have purchased a LVR Packet
Option # 1
Upgrade to Previous Customers who have purchased an
earlier version
Complete Packet on CD-R
$25.00
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Option # 2
Upgrade of only the LVR
sent to Previous Customer
by E-mail
$15.00
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5 MUST for Every Private Practice IBCLC
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# 1
Click on book to order
from Hale Publishing
By Linda J. Smith & 15 private practice
contributing authors
Price: $43.95 (U.S. List)
Cover: Paperback Pages: 288
Copyright: 2002
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# 2
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# 3
The Lactation Visit Receipt Packet
by Pat Lindsey, IBCLC
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# 4
Kelly Bonyata, BS, IBCLC's
Out of the 2,163 candidates for the IBLCE 2004 Exam, Kelly scored the highest grade.
When it comes to handouts, why re-invent the wheel?
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# 5
Click on book to order
from Hale Publishing
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© 2001 Pat Lindsey, IBCLC - Lactation Services all rights reserved.
This internet site provides information of a general nature.
If you have any concerns about your own health or the health of your child, you should
always consult with a physician or other healthcare professional.
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