Pump Serial Number District Inventory Number State level WIC or Local WIC Program Identify “Purchased By” – Purchase Purchase Price Purchase Date Client Contact Information Cleaning Condition of the Pump Tracking Documentation Assign a multi-user (See Attachment BF - 2) “Tracking Log” form. Mark all multi user pumps and cases with: Contact information WIC Program 1-800-228-9173” “Georgia District Inventory Number Tracking of Personal Double Pumps (PDP) and Manual Pumps Prior to storage and issuance of manual pumps, Personal Double Pumps (PDP), adaptors, breast pads, storage bags, and breast shields, inventory received in the clinic Breast Pump tracking log notebook. (See Document Attachment BF - 3) Storage of Pumps Pump inventory must be stored and secured in a locked space accessible only by WIC staff. Pump Issuance and Guidance (All Breast Pumps) Pump issuance must be provided only by WIC authorized personnel, including CPA’s, Breastfeeding and Peer Counselors(PC), CLC’s, Lactation Consultants. However, PC’s are not allowed to clean pumps or manage the pump program; including, tracking or inventorying pumps. (See PC Program Guidelines FY2016). Note: Breast pumps are loaned free of charge, without a monetary deposit. The following information must be reviewed as part of the pump issuance process. Assess the individual needs of the participant and select the appropriate pump for for Issuing Breast and Attachment her situation. See “Guidelines Pumps” BF - 4 Quick Reference to Issuing Breast Pumps. Demonstrate Hand expression. Refer clients to Demonstrate assembly and use of the pump, as well as milk collection kit. Provide instructions for cleaning. Allow participant to demonstrate assembly and verbally explain how to clean the pump and kit. Explain proper milk storage guidelines; as well as how the participant will establish or maintain milk supply. Complete and file a Pump Release and form for each pump “Breast Liability” issued; file at the issuance clinic. (See Attachment BF - 5) Document information shared in participant’s medical record.
Pump Serial Number District Inventory Number Identify “Purchased By” – State level WIC or Local WIC Program Purchase Purchase Price Purchase Date Client Contact Information Cleaning Condition of the Pump Tracking Documentation Assign a multi-user “Tracking Log” form. (See Attachment BF - 2) Mark all multi user pumps and cases with: Contact information “Georgia WIC Program 1-800-228-9173” District Inventory Number Tracking of Personal Double Pumps (PDP) and Manual Pumps Prior to storage and issuance of manual pumps, Personal Double Pumps (PDP), adaptors, breast pads, storage bags, and breast shields, Document inventory received in the clinic Breast Pump tracking log notebook. (See Attachment BF - 3) Storage of Pumps Pump inventory must be stored and secured in a locked space accessible only by WIC staff. Pump Issuance and Guidance (All Breast Pumps) Pump issuance must be provided only by WIC authorized personnel, including CPA’s, Breastfeeding Peer Counselors(PC), CLC’s, and Lactation Consultants. However, PC’s are not allowed to clean pumps or manage the pump program; including, tracking or inventorying pumps. (See PC Program Guidelines FY2016). Note: Breast pumps are loaned free of charge, without a monetary deposit. The following information must be reviewed as part of the pump issuance process. Assess the individual needs of the participant and select the appropriate pump for her situation. See “Guidelines for Issuing Breast Pumps” and Attachment BF - 4 Quick Reference to Issuing Breast Pumps. Demonstrate Hand expression. Refer clients to Demonstrate assembly and use of the pump, as well as milk collection kit. Provide instructions for cleaning. Allow participant to demonstrate assembly and verbally explain how to clean the pump and kit. Explain proper milk storage guidelines; as well as how the participant will establish or maintain milk supply. Complete and file a “Breast Pump Release and Liability” form for each pump issued; file at the issuance clinic. (See Attachment BF - 5) Document information shared in participant’s medical record.
Final%20BP%20policy%20for%20ME%20submission%202.docx