FBC Breastfeeding Friendly Medical Office Pilot

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We are happy to launch our pilot enrollment. Requirements of the pilot include: 1)assign a designee from their medical office or practice to serve as office breastfeeding lead for the 6 month pilot project, 2) participate in monthly pilot meetings, 3) complete pre and post survey evaluations, and 4) apply for Breastfeeding Friendly Medical Office designation. Please complete this application if your medical office is interested in participating in our 6 month pilot to evaluate the program criteria, education and application process. Deadline for submission of the pilot application is due October 15th, 2021. All applications will be reviewed and notified of being selected after committee review by November 30th, 2021. Contact us at flbreastfeedingcoalition@gmail.com with questions.

Name of Medical Office

Office Pilot Lead Person

Office Pilot Lead Contact Information (email and phone number)

Office Address and location

Number of employees including administrative, medical assistant and medical providers (e.g. -physicians, physician assistant or nurse practitioner).

Please explain why you would like to participate in the pilot.

Please check which items your office would like support with:

Breastfeeding policy

Breastfeeding materials for patients

Breastfeeding education and training for staff

Breastfeeding support for patients

List of community resources

Information on billing and coding for breastfeeding visits

Breast pump information

Other:

Thank you for your interest in our pilot project, expect to hear from us by November 30th, 2021. Please provide any additional information or comments.

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