How do you organize a lactation report to a provider?

by Liz Flight May 2021

Did you ever wonder about charting? Years ago, both doctors and nurses wrote a lengthy narrative description of a patient’s condition, treatment, and their responses to any treatments in large paper files. These included records of vital signs, mental status, a description of each of the patient’s “systems” and such. When charting nurse’s care, the SOAP note was a common format for inpatient charting episodes in succession. With the advent of electronic charting, narrative charting has become a lost art.  MilkNotes has taken the “old” method of charting and brought it up to date!

Have you wondered how to best organize the information without spending an hour writing? 

The initials, “SBAR” stand for Situation, Background, Assessment, and Recommendations. The acronym was initially adapted from the fields of Navy submarine and aviation to improve communication and prevent errors.  In lactation, we use it to describe an encounter with the client and for clear and concise communication with the providers.   It is perfectly suited for outpatient care as it can encompass and synopsize the history and background to provide the backbone for the assessment and plan.

SBAR Categories

  • Situation: State the problem
  • Background: History
  • Assessment: Observation of the issue related to situation and background
  • Recommendations: What is needed and how urgently

To put that into a more medical context, it’s much like SOAP (Subjective, Objective, Assessment, Plan) The “Situation” is the parent’s perception or description of the problem. “Background” includes medical history, symptoms, and birth history.  “Assessment” describes the observation of the feeding and the actual physical assessment of parent and child. “Recommendations” include the patient care plan, referrals to other ancillary providers, and links to educational handouts and URLs.  This is all pulled together in the Provider Report for you which is automatically signed, dated and timed.

In comparison, the SOAP method is designed for a “Subjective” sentence which is that the patient said or described about what brought them in; i.e., “My nipples hurt when s/he nurses.”  “Objective” is a description of everything that you see, such as a description of the wounds, the baby in latch position, and the overall feeding.  “Assessment” is really only a sentence that is comparative to a nursing diagnosis; “Damaged nipples secondary to shallow latch.” Finally, the “Plan” is a numbered list of what should be done to alleviate the problem. This is followed by a signature, date and time.

In an outpatient setting, the SBAR method of recording a parent/child encounter makes it easy to communicate with the other providers and is a legal record of your actions. The unique feature within MilkNotes charting is that the parent and child have individual “charts” that are linked by the date and time of the “encounter” for ease of reporting on them individually or in a combined chart. You still document on both at the same time which saves time by preventing repetition of information or duplication your charts.

Electronic charting with MilkNotes simplifies the repetitive tasks so that LCs can put more focus on their care for families. It’s a high-tech solution for a high touch profession.

Version 30 Notes

So excited to share some great news just in time for Mother’s Day!!! You all deserve to have the best platform to use for supporting your clients and I’m doing everything possible to make this happen. We have come a long way from the original Access Database (2011) to The Lactation Note (2014) to the foundation of MilkNotes and MilkNotes Pro as a web-based application (2016).  For our Mother’s Day release, the platform has been enhanced to include the following:

  • On the Child’s Background tab, we have added the age of the baby (in days) next to the weight/date fields. This feature does the age calculations for you on the screen. 
    • Based on numerous requests from our users, we have also added the ability for the LC to easily see the baby’s birthdate when adding the Birth Weight on the Background tab to our development roadmap. Look for this additional feature soon.
  • The Provider Report Fax is now a larger font, not limited to one page, and will include a list of the names of your handouts included in your parent’s Care Plan from the Recommendations Tab. This will eliminate any need to repeat yourself within the Provider/Medical Report.
  • We have added a Birth Location field to the Child’s Background tab. You can now type add the name of the facility where the infant was born to the child’s history. Just add a new item to the list or select an existing item.
  • We have added the ability to sort the Provider names by alphabet to make selection easier and to make editing more efficient. Dropdown selection lists are now sorted by first name to make finding them easier when you are charting.
  • Additional types have been added to the Provider Type dropdown list.
  • On the Child’s Assessment tab, instead of only the insertion of one number in the feedings history area, you have free text which allows documentation such as “3-4 oz”, etc.
  • The Skin to Skin at Birth field has been changed to minutes. All existing entries were converted to minutes
  • We added some field labels and removed the default selection for allergies on the Parent Intake. We will continue to gather feedback from all of you and continue to enhance the Parent Intake experience in the future.
  • This one was for me!  I have interns and contractors and instead of the default always starting with my name, there is now the ability to select “all consultants” and have it remain the default!!!  That way I see the whole week’s appointments at a glance!!

The last year has been full of unprecedented challenges for all of us and we, at MilkNotes, are right there with you. We have other items on our agenda for future development and are very open to your suggestions. If you are a MilkNotes Pro user, we invite you to send us your information to be listed on our website as a provider.  

We are also announcing that we are opening our blog to those of you who are part of our MilkNotes Family.  I would love to see what you are thinking about with regard to breastfeeding, private practice, babies, charting, any topic that interests you. If you like to write and have a talent for expressing your thoughts in written form, we would love to have you submit articles for our MilkNotes blog. It won’t be possible for us to publish all of them, but we want to tap into the wealth of knowledge and experience that all of you have. If you would like more information about how to submit an article for review, email I look forward to seeing the diversity of knowledge within our MilkNotes family.

In light of the recent COVID-19 situation we want to encourage everyone to stay strong during this stressful time.  So many areas have gone into quarantine making it difficult to provide services like home or office visits, but we are here to support you! 

To help you meet the needs of your clients, we are making HIPAA-compliant VideoCare available to all of our MilkNotes subscribers until April 30th.  After April 30th, we will evaluate whether or not to continue this offering based on the status of the Coronavirus quarantine and/or isolation order at that time but we want this resource available to everyone in this time of need. Please be patient as we ramp up the resources needed to provide this additional service. 

Again, we are here for you! Thank you for being a part of this incredible community.

Version 24 Released!


Say hello to the 24th update that was released 9/1/19. Version 24 focuses on communication upgrades - some requested by you and others we added because, well... we think you’ll love them. All features and fixes are Pro Features except where noted otherwise. Here are the highlights of Version 24.



Secure Messaging Improvements:
  • Messages are now sent and received in Real-Time
  • New Message Icon indicator - displays total number of new messages
  • New “Message List” shows all unread messages from all parents
  • New/unread message counter automatically updates
Faxing improvements:
  • “Sent Faxes” list
  • Improved reliability
  • Provider and Practice Names now included in fax cover sheet
  • Ability to adjust appointment time and duration from within the calendar
  • Ability to configure whether or not to show duration on the public


  • Improved check mark visibility on SuperBill
  • Payment confirmation was not being shown in specific situations
  • Removed ability to add a blank insurance provider
  • Enabled scrolling on Consent and HIPAA forms (Starter Plan)
  • Screen was not scrolling to new messages when the message window required scrolling

Version 21 will be released the morning of


Version 21 is scheduled to be released Friday morning! As always, you don’t have to download anything to view these updates. Simply log out of MilkNotes and refresh your browser. To verify MilkNotes has updated, reference the version number on the bottom left corner of the main menu.

Version 21 Features

The major feature this release is Calendar Views now on Dashboard and Visits pages. This is NOT scheduling but a precursor to scheduling that will be available very soon!

Pro Plan Features

  • Add & Edit Appointments in Calendar View
  • Monthly Calendar View on Dashboard
  • Weekly Calendar View on Visits Page
  • Added insured’s name and date of birth to SuperBill
  • Added “Secure Messaging” as an option in the Preferred Method of Communication list

Starter Plan Features

  • Added “Oversupply” to ICD10 code list
  • Consult Locations has been replaced with Appointment Types
  • Minor bug fixes

This is how you complete a super bill on IOS with MilkNotes

Download the adobe acrobat IOS app.

Log in to MilkNotes on safari and navigate to the visit that requires a super bill. Under the more button, you’ll find the option to download the super bill. Once the super bill loads you’ll notice that MilkNotes has pre-populated your practice information and the clients profile information.

Click the share button on the top right corner of the browser on iPad or bottom middle section on an iPhone, now select “copy to adobe acrobat.” Once in acrobat, fill in the remaining information into your super bill using the editable fields.

To add the necessary signatures, click the pencil button on the bottom right corner and then select “fill and sign.” This will open the pen tool at the top menu. Tap the pen icon at the top and then select “create signature.” Make sure you toggle off “save to online profile” for your clients signatures as this is not HIPAA compliant.

Use your finger or stylus to sign in the box, press done, and then tap to place it in the desired field. You can use the arrow tools next to the signature to resize as needed.

Once completed, acrobat automatically saves the super bill under the acrobat folder in your iOS files. You may rename the file in acrobat to make it more identifiable. Please ensure you do not back up the super bill to the adobe cloud or iCloud, as this may not be HIPAA compliant.

Navigate back to the profile of your client and scroll down to the documents section. Expand the section, press choose, and then browse. Your completed super bill should be in your recent documents, but you can also find it on your iOS device under the acrobat folder. Select your document and when it’s finished uploading it will be securely stored for you and your clients reference.

This is how you search your MilkNotes Visits

Navigate to your visits page. On this page there is  a search bar above the left pending visits column. Type the name of the client you’re searching for.

If you are in a practice with more than one LC and have permission from the admin, you will also have the option to search for other LC’s clients. That filter option is immediately to the right of the search bar.

This is how you close a MilkNotes visit

If you’re not already in the visit, Navigate to your visits page. Select the visit that needs to be closed. In the top right corner click the more button then close visit.

Closing a visit permanently secures the medical information and prevents further tampering. If you need to add additional information after the visit has been closed, you can always add a post visit note. Once a visit is closed it will now be in your previous visits column on the visits page.

This is how you send a secure message on MilkNotes

Log into MilkNotes and navigate to your visits. Select the visit your communication is in reference to. If you haven’t already, make sure your clients valid email address is in their profile and send them a parent portal registration link.

The messages button is on the top right hand side of every section of the visit. On some devices messages may be under the ellipsis button. Click messages and then new message.

Here you can type and send your secure message. Your client will then be notified in their email that they have a message waiting for them in their MilkNotes parent portal. You can now have secure and HIPAA compliant communication with your clients.

This is how you upgrade to MilkNotes Pro

MilkNotes Pro has many wonderful features that you can use to manage your lactation practice. When you upgrade to MilkNotes pro you will be able to utilize these features such as:

Secure Messaging



Rental pump tracking

and a Fully customizable care plan

To upgrade to Pro, click admin in the left menu and then LC list. At the top is an option to upgrade. Choose an Annual or monthly plan, and then enter in your card information. Congratulations! You’re now a MilkNotes Pro user.