Therapeutic Laser Treatment Consent

This consent applies only to therapeutic laser treatment provided by Bayou City Breastfeeding. Therapeutic laser treatment is not cosmetic, aesthetic, surgical, or hair-removal laser treatment.

Relationship to chiropractic care

Therapeutic laser treatment is offered only as part of a chiropractic treatment plan. Before therapeutic laser treatment is provided, I or my child must be evaluated by a Bayou City Breastfeeding chiropractor. The chiropractor will determine whether therapeutic laser treatment is appropriate and will define the course of treatment.

Once the chiropractor has defined the treatment plan, therapeutic laser treatment may be provided by the chiropractor or by a person who has completed Bayou City Breastfeeding's required laser operator training and is acting within the chiropractor-defined treatment plan.

Therapeutic laser treatment is provided only in a laser-specific visit. It is not provided during a general lactation visit.

Purpose of therapeutic laser treatment

Therapeutic laser treatment uses light energy applied to targeted areas of the body. It may be used as part of a treatment plan to support comfort, tissue response, inflammation management, musculoskeletal function or lactation-related care when clinically appropriate. No specific result is guaranteed.

What may happen during treatment

During therapeutic laser treatment, the provider or trained laser operator may confirm the treatment area and treatment plan defined by the chiropractor; ask screening questions before treatment; apply laser light to one or more areas identified in the treatment plan; require protective eyewear for me, my child when applicable, the provider or operator, and anyone else in the treatment area; and stop or modify treatment if there is discomfort, a safety concern, or another reason treatment should not continue.

A trained laser operator may provide only the therapeutic laser treatment defined by the chiropractor. The laser operator does not diagnose conditions, create a chiropractic treatment plan, change the treatment plan, or provide lactation care during a laser-specific visit.

Possible benefits

Possible benefits may include improved comfort, reduced tenderness, improved mobility, support for tissue healing or function, and improved ability to participate in other recommended care. Results vary. Therapeutic laser treatment may not improve symptoms, function, feeding, pain, inflammation, tissue response, or healing.

Risks and side effects

Possible risks and side effects include temporary warmth, tingling, or discomfort; temporary increase in symptoms; skin redness or irritation; tenderness or soreness after treatment; headache, dizziness, or fatigue; eye injury if protective eyewear is not used properly; aggravation of an existing condition; and no improvement in symptoms. Rare risks may include burns, pigment changes, or worsening of an undiagnosed condition.

Contraindications and precautions

Therapeutic laser treatment may not be appropriate for every patient. I agree to tell Bayou City Breastfeeding before treatment if I or my child am pregnant or may be pregnant; have cancer, a history of cancer, or an unexplained mass; have a pacemaker, implanted electronic device, or implanted medical device; have seizures or light sensitivity; take photosensitizing medication; use steroids, immune-suppressing medication, antibiotics, or other medications that may affect tissue response; have an autoimmune condition; have a bleeding disorder or clotting disorder; have impaired sensation in the treatment area; have active infection, fever, rash, burn, open wound, or skin condition in the treatment area; have recently had surgery, trauma, injection, or another procedure in the treatment area; or have any condition or concern that may affect whether therapeutic laser treatment is safe.

Bayou City Breastfeeding may decline, delay, modify, or stop therapeutic laser treatment based on health history, symptoms, provider judgment, treatment-plan limits, or safety concerns.

Pregnancy

If I am pregnant or may be pregnant, I will tell the chiropractor before any laser treatment. BCB does not provide therapeutic laser treatment to the abdomen, pelvis, lumbar spine, or any area over a known or suspected pregnancy. Treatment to other areas during pregnancy is provided only after the chiropractor documents a device-specific benefit-risk discussion with me and confirms the device's manufacturer guidance permits the proposed use.

Therapeutic Laser Treatment for Lactation Indications

Bayou City Breastfeeding most often uses therapeutic laser to support lactation-related care, including plugged or clogged ducts, mastitis (under the requirements set out below), engorgement, blebs, cracked or damaged nipples, and inflammation or discomfort related to feeding. The laser used for these indications is the same FDA-cleared Class 4 therapeutic laser used elsewhere in BCB's chiropractic care plans. Lactation-specific use of therapeutic laser is generally considered an off-label use of the device. Off-label use is permitted in clinical practice and is disclosed here for informed consent.

Chiropractor evaluation required. A Bayou City Breastfeeding chiropractor will evaluate me and define the treatment plan before any laser treatment is provided for a lactation indication. After the treatment plan is defined, individual laser sessions may be administered by the chiropractor or by a trained laser operator acting within that plan, on the same model as chiropractic-related laser treatment. The trained laser operator does not diagnose, modify the treatment plan, or treat outside the plan.

Mastitis and infection requirements. Therapeutic laser does not treat the underlying infection in mastitis. To receive laser treatment for a lactation indication, I must be fever-free at the time of treatment. If I have been diagnosed with mastitis, I must have been on an appropriate course of antibiotics for at least 48 hours before laser treatment is administered. Laser treatment in this setting is adjunct supportive care and does not replace medical treatment of infection.

Symptoms requiring medical evaluation, not laser. I will pause laser treatment and contact a physician (or seek emergency care) if I experience any of the following: fever above 100.4°F (38°C); worsening redness, pain, or swelling; systemic symptoms such as chills, body aches, or feeling generally unwell; a hardened mass that does not resolve; or suspected abscess. These signs may indicate progressing infection and require medical evaluation, not additional laser sessions.

Breast mass and cancer screening. Therapeutic laser is not a screening or diagnostic tool for breast cancer or other breast disease. Any unexplained breast mass or lump must be evaluated by a physician before laser treatment is provided to that area. By signing this consent I confirm that I have no unevaluated breast mass, or that any unexplained mass has been evaluated by a physician and the chiropractor has been informed before laser treatment.

Specific contraindications and disclosures for breast-tissue laser. I will tell the chiropractor before any breast-tissue laser treatment if I have or have had: active or suspected breast cancer or any unexplained breast mass; recent breast surgery (including augmentation, reduction, lumpectomy, or biopsy) without surgeon clearance; silicone or saline breast implants (the chiropractor will discuss device-specific guidance); active fever, open wound, actively bleeding nipple, or skin infection in the treatment area; herpes simplex outbreak in or near the treatment area; photosensitizing medication; recent corticosteroid injection in the area; or any condition or concern that may affect whether laser treatment is safe. The chiropractor may decline, delay, modify, or stop laser treatment based on these or other safety concerns.

Treatment timing — empty-breast recommendation. Bayou City Breastfeeding recommends that breast-tissue laser treatment be performed on an empty breast. I may breastfeed or pump before treatment to ensure the breast is empty. Breastfeeding after laser treatment is not restricted by the treatment.

Modesty and privacy. Breast-tissue laser treatment requires breast exposure. Treatment is provided in a private room. I may request a chaperone (subject to staff availability), request additional draping, or ask to stop treatment at any time. I may have a support person present in the room if I choose, subject to BCB's safety access controls during laser use.

Eye protection — Class 4 specifics. Bayou City Breastfeeding uses Class 4 therapeutic lasers (Fotona xPulse and EVO D30). Class 4 lasers carry eye-injury risk including from diffuse reflections. Wavelength-matched protective eyewear is required for the patient, the provider, the trained laser operator, and any other approved person in the treatment area whenever the laser is energized, and must remain on for the entire energized period. Because breast-tissue treatment positions the laser closer to my eyes than musculoskeletal treatment, my eyewear is especially important. No infant or child may be present in the laser-controlled area during a breast-tissue laser session; an adult support person, if present, must wear protective eyewear.

Right to decline or stop. I may decline or stop breast-tissue laser treatment at any time. Declining or stopping will not affect my access to other care from Bayou City Breastfeeding.

Trained Laser Operator

"Trained laser operator" means a person who has completed BCB's required laser operator training (which includes laser-safety education consistent with ANSI Z136.3 and the manufacturer's training for the specific device in use), and who acts within a chiropractor-defined treatment plan. The supervising chiropractor remains responsible for the treatment plan and for the laser operator's adherence to it. The laser operator does not diagnose, modify the treatment plan, or treat outside the plan.

Device Disclosure

BCB uses FDA-cleared therapeutic laser devices for indications consistent with the device's clearance. The make, model, class, and 510(k) clearance information for the device used in my treatment is available on request.

Eye protection and safety rules

Protective eyewear is required for the patient, any required caregiver in the treatment area, the provider, the trained laser operator, and any other approved person in the treatment area whenever the laser is energized. I will not remove the eyewear unless instructed by the provider or operator. I understand that looking directly at laser light or reflected laser light can cause permanent eye injury. I will not photograph or video the laser beam during treatment.

Only the patient, required caregiver, provider, trained laser operator, or approved trainee may be present in the treatment area during laser use.

Treatment-plan limits

Therapeutic laser treatment will be provided only within the plan defined by the chiropractor. If I request treatment to a different area, report new symptoms, report worsening symptoms, or need a change in treatment, the laser operator may pause treatment and refer me back to the chiropractor for review.

A laser-specific visit is limited to laser treatment and related safety screening. It does not include a general lactation consultation, chiropractic re-evaluation, new diagnosis, or new treatment planning unless separately scheduled with the appropriate provider.

Alternatives

Alternatives may include no therapeutic laser treatment; chiropractic care without therapeutic laser treatment; lactation care without therapeutic laser treatment; referral to another healthcare provider; home care, positioning changes, therapeutic exercise, or other conservative care; or medical evaluation or treatment by a licensed medical provider. I may decline therapeutic laser treatment.

Right to stop treatment

I may ask questions before or during treatment. I may decline or stop therapeutic laser treatment at any time. Declining therapeutic laser treatment will not prevent me from receiving other services that are appropriate and available.

Emergency and medical concerns

Therapeutic laser treatment is not emergency medical care. If I or my baby has urgent or emergency symptoms, I should contact a physician or pediatrician, call 911, or go to the nearest emergency department.

AI-Supported Documentation Consent Bayou City Breastfeeding may use Heidi Health, an AI-supported medical documentation tool, to assist with clinical documentation during my visit. If AI-supported documentation is used, Heidi Health may capture audio and create a transcript for the purpose of preparing draft visit notes, care plans, and provider reports.

AI-supported documentation does not replace my clinician’s judgment. My clinician remains responsible for reviewing, correcting, and finalizing the medical record.

Heidi Health acts as a HIPAA Business Associate of Bayou City Breastfeeding to the extent it creates, receives, maintains, or transmits protected health information on Bayou City Breastfeeding’s behalf, and Bayou City Breastfeeding has a Business Associate Agreement with Heidi Health.

If AI-supported documentation is used, audio and transcript data will be handled in accordance with BCB's Business Associate Agreement with Heidi Health. As of the effective date of this consent, that BAA provides that audio recordings are not retained after the clinical note is generated, that Heidi Health does not use recordings to train its AI models, and that Heidi Health personnel or subcontractors may access recordings or transcripts only for support, troubleshooting, or quality-assurance purposes consistent with HIPAA Business Associate obligations. If BCB's BAA with Heidi Health materially changes, BCB will update this consent and will provide notice on its website.

I may decline AI-supported documentation at any time before or during my visit without affecting the care I receive. If I decline, my clinician will document the visit manually.

Photography and Video for Care

I give permission to Bayou City Breastfeeding to photograph or record video of me and/or my baby in furtherance of care. Images and recordings will be captured only on practice-issued or practice-approved devices using encrypted storage, will be retained as part of my medical record in accordance with Bayou City Breastfeeding's records-retention policy and applicable law, and will be deleted from any personal device promptly after being added to the medical record. These images or recordings will not be published or used for marketing, education, or any non-treatment purpose without my separate written consent through Bayou City Breastfeeding's separate HIPAA Marketing Authorization but may be shared with my or my baby's healthcare team when needed for treatment or coordination of care.

Photography for breast-tissue treatment. Bayou City Breastfeeding may photograph treated breast tissue for clinical documentation. Photographs are captured only on practice-issued or practice-approved devices, are uploaded directly to BCB's Jane practice management system, and are stored only as part of my medical record. Photographs are not retained on personal or staff devices after upload. Photographs of breast tissue are not used for marketing, educational, or any non-treatment purpose without my separate written consent through BCB's HIPAA Marketing Authorization.

I may decline photography or video recording for care purposes, and declining will not affect my ability to receive other services.

Payment and scheduling

Therapeutic laser treatment may be billed separately from lactation or chiropractic services. Insurance coverage is not guaranteed. Payment, cancellation, card-on-file, and insurance terms are addressed in the Payment-Related Consent.

Right to Withdraw Consent

I may withdraw my consent to any aspect of care at any time, for any reason, by communicating my withdrawal to Bayou City Breastfeeding in writing or verbally to the provider. Withdrawing consent to a specific element of care — for example, the assessment of me or my baby, AI-supported documentation, or photography — will not affect the availability of other aspects of care, and will not result in retaliation or penalty.

Electronic Signature, Governing Law, and Scope

Electronic Signature. If I sign this consent electronically, my electronic signature has the same legal effect as a handwritten signature under the federal E-Sign Act (15 U.S.C. §7001) and the Texas Uniform Electronic Transactions Act. The General Consent contains the full E-Sign consumer disclosure block applicable to all Bayou City Breastfeeding forms I sign.

Governing Law. This Consent is governed by the laws of the State of Texas. Severability. If any provision of this consent is held invalid or unenforceable, the remaining provisions will remain in full force and effect.

Scope: This document addresses the matters set out above and does not limit or supersede any separate document I sign with Bayou City Breastfeeding, including the General Consent, the Treatment Consent for the service I am receiving, any Good Faith Estimate, or any other practice form or policy.