{"id":7116,"date":"2026-01-01T22:53:37","date_gmt":"2026-01-02T04:53:37","guid":{"rendered":"https:\/\/healthfund.org\/a\/?page_id=7116"},"modified":"2026-01-01T22:53:39","modified_gmt":"2026-01-02T04:53:39","slug":"high5-premier-renewal-26","status":"publish","type":"page","link":"https:\/\/healthfund.org\/a\/high5-premier-renewal-26\/","title":{"rendered":"High 5 for Mom &amp; Baby Premier Renewal 2026"},"content":{"rendered":"\n<p><strong>Kansas Hospitals and Birth Centers<\/strong>: use this streamlined online form to apply for renewal of recognition as a <em>High 5 for Mom &amp; Baby Premier<\/em> facility. If helpful, you can <a href=\"https:\/\/healthfund.org\/a\/wp-content\/uploads\/High-5-Premier-Renewal-Form-SAMPLE.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">download an offline sample<\/a> to gather the information to enter into the official online form below. <\/p>\n\n\n\n<p>If you have questions about <a href=\"https:\/\/high5kansas.org\">High 5 for Mom &amp; Baby<\/a> or the renewal process, please contact program coordinator Cara Gerhardt coordinator@high5kansas.org. Thank you for your continued commitment to helping ensure successful breastfeeding for Mom &amp; Baby!<\/p>\n\n\n\n<p><em>Note: upon submission of the below form, an email confirmation will be sent to the address entered in the email field below. If you want to save a partial form for later completion, please use the Save Draft function at the bottom of the form. <\/em><\/p>\n\n\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_103_container\" data-token=\"f337922ff825d3e0bb950eeca05d102a\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_ajax_submit  frm_pro_form \" id=\"form_high-5-premier-renewal-26\" data-token=\"f337922ff825d3e0bb950eeca05d102a\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">High 5 Premier Renewal Application 2026<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"103\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_103\" id=\"frm_hide_fields_103\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"high-5-premier-renewal-26\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_103\" name=\"frm_submit_entry_103\" value=\"58f0524d88\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/a\/wp-json\/wp\/v2\/pages\/7116\" \/><div id=\"frm_field_1431_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">High 5 Premier Renewal Application 2026<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1424_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_eafyq\" id=\"field_eafyq_label\" class=\"frm_primary_label\">Date\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_eafyq\" name=\"item_meta[1424]\" value=\"04\/16\/2026\"  data-sectionid=\"1431\"  maxlength=\"10\" data-frmval=\"04\/16\/2026\" data-reqmsg=\"Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1425_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_ckd9s\" id=\"field_ckd9s_label\" class=\"frm_primary_label\">Facility Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ckd9s\" name=\"item_meta[1425]\" value=\"\"  data-sectionid=\"1431\"  data-reqmsg=\"Facility Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Facility Name is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1426_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_iji8\" id=\"field_iji8_label\" class=\"frm_primary_label\">Facility City\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_iji8\" name=\"item_meta[1426]\" value=\"\"  data-reqmsg=\"Facility City cannot be blank.\" aria-required=\"true\" data-invmsg=\"Facility City is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1427_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<div  id=\"field_mg19w_label\" class=\"frm_primary_label\">Your Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_mg19w_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tYour Name\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_1427\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1427-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_mg19w_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_mg19w_first\" value=\"\" name=\"item_meta[1427][first]\" autocomplete=\"given-name\" data-sectionid=\"1431\"  data-reqmsg=\"Your Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_1427_first_desc\">First Name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1427-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_mg19w_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_mg19w_last\" value=\"\" name=\"item_meta[1427][last]\" autocomplete=\"family-name\" data-sectionid=\"1431\"  data-reqmsg=\"Your Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_1427_last_desc\">Last Name<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1428_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n\t<label for=\"field_e5thy\" id=\"field_e5thy_label\" class=\"frm_primary_label\">Email\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_e5thy\" name=\"item_meta[1428]\" value=\"\"  data-sectionid=\"1431\"  autocomplete=\"email\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_conf_1428_container\" class=\"frm_form_field frm_hidden_container frm_conf_field form-field  frm_required_field frm_top_container  frm6\">\r\n\t<label for=\"field_conf_e5thy\" id=\"field_conf_e5thy_label\" class=\"frm_conf_label frm_primary_label\">Confirm Email\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_conf_e5thy\" name=\"item_meta[conf_1428]\" value=\"\"  data-sectionid=\"1431\"  autocomplete=\"email\"  placeholder=\"Confirm email\" data-reqmsg=\"Confirm Email cannot be blank.\" aria-required=\"true\" data-confmsg=\"The entered values do not match\" data-invmsg=\"Confirm Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_conf_e5thy\"\/>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_conf_e5thy\">Confirm email<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1429_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_ovydp\" id=\"field_ovydp_label\" class=\"frm_primary_label\">Number of deliveries last year\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_ovydp\" name=\"item_meta[1429]\" value=\"\" data-sectionid=\"1431\"  data-reqmsg=\"Number of deliveries last year cannot be blank.\" aria-required=\"true\" data-invmsg=\"Number of deliveries last year is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_2174_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Informational Questions<\/h3>\r\n<div id=\"frm_desc_field_c3bhw\" class=\"frm_description frm_section_spacing\">The questions in this first section are intended to inform potential future improvements to High 5, and your responses will not affect renewal eligibility in any way. We appreciate your input.<\/div>\r\n\r\n<div id=\"frm_field_2176_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_ln485_label\" class=\"frm_primary_label\">1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ln485_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_2176-2174-0\">\t\t\t<label  for=\"field_ln485-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[2176]\" id=\"field_ln485-0\" value=\"Yes\"\n\t\t data-sectionid=\"2174\"  data-invmsg=\"1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_2176-2174-1\">\t\t\t<label  for=\"field_ln485-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[2176]\" id=\"field_ln485-1\" value=\"No\"\n\t\t data-sectionid=\"2174\"  data-invmsg=\"1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation? is invalid\"   \/> No<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_2176-2174-2\">\t\t\t<label  for=\"field_ln485-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[2176]\" id=\"field_ln485-2\" value=\"Uncertain\"\n\t\t data-sectionid=\"2174\"  data-invmsg=\"1. Does your facility currently offer pasteurized\u00a0donor human milk to patients who require feeding supplementation? is invalid\"   \/> Uncertain<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_2177_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_g4wwy\" id=\"field_g4wwy_label\" class=\"frm_primary_label\">1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"hidden\"  data-sectionid=\"2174\"  data-invmsg=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk. is invalid\" aria-invalid=\"false\"   name=\"item_meta[2177][]\"  value=\"\" data-frmfile=\"2177\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file2177_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file2177[]\" id=\"field_g4wwy\"\n\t\t\t data-frmfile=\"2177\" multiple=\"multiple\"  data-sectionid=\"2174\"  data-invmsg=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk. is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk.. Drop a file here or click to upload. Maximum file size: 67.11MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"1a. If yes, please attach any policies,\u00a0handouts, or documentation you use\u00a0related to providing pasteurized donor human milk.. Choose File. Maximum file size: 67.11MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 67.11MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_2178_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_1isky_label\" class=\"frm_primary_label\">1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1isky_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-0\">\t\t\t<label  for=\"field_1isky-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-0\" value=\"Cost\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Cost<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-1\">\t\t\t<label  for=\"field_1isky-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-1\" value=\"Uncertainty about how to obtain donor milk\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Uncertainty about how to obtain donor milk<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-2\">\t\t\t<label  for=\"field_1isky-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-2\" value=\"Provider concerns\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Provider concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-3\">\t\t\t<label  for=\"field_1isky-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-3\" value=\"Provider lack of interest\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Provider lack of interest<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-4\">\t\t\t<label  for=\"field_1isky-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-4\" value=\"Family concerns\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Family concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-5\">\t\t\t<label  for=\"field_1isky-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-5\" value=\"Family lack of knowledge or interest\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Family lack of knowledge or interest<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-6\">\t\t\t<label  for=\"field_1isky-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-6\" value=\"Storage concerns\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Storage concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-7\">\t\t\t<label  for=\"field_1isky-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-7\" value=\"Workflow issues or concerns\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Workflow issues or concerns<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-8\">\t\t\t<label  for=\"field_1isky-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][]\" id=\"field_1isky-8\" value=\"Safety of donor milk\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Safety of donor milk<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_2178-2174-other_10\">\t\t\t<label  for=\"field_1isky-other_10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[2178][other_10]\" id=\"field_1isky-other_10\" value=\"Other\"  data-sectionid=\"2174\"  data-invmsg=\"1b. If no, what are the barriers to offering pasteurized human donor milk? (Please choose all which apply) is invalid\"   \/> Other<\/label><label for=\"field_1isky-other_10-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_1isky-other_10-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][2178][other_10]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1456_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h4><strong>The following Facility Self-Assessment questions relate to the evidence-based High 5 for Mom &#038; Baby practices supporting successful breastfeeding. <\/strong><\/h4>\n<h4><strong><em>Application responses should accurately reflect hospital policies and the patient education provided by trained staff.\u00a0<\/em><\/strong><\/h4>\n<p><strong>High 5 for Mom &#038; Baby Premier<\/strong> facilities should answer questions relating to all ten High 5 for Mom &#038; Baby practices. Facilities continuing to follow all ten practices will remain eligible for <strong>High 5 for Mom &#038; Baby Premier<\/strong> recognition.<\/p>\n<p><strong>The High 5 for Mom &#038; Baby Practices:<\/strong><\/p>\n<ol>\n<li>Facility will have a written maternity care and infant feeding policy addressing the High 5 for Mom &#038; Baby practices supporting breastfeeding<\/li>\n<li>Facility will maintain staff competency in lactation support<\/li>\n<li>All pregnant women will receive information and instruction on breastfeeding<\/li>\n<li>Assure immediate and sustained skin-to-skin contact between mother and baby after birth<\/li>\n<li>All families will receive individualized infant feeding counseling<\/li>\n<li>Give newborn infants no food or drink other than breastmilk unless medically indicated<\/li>\n<li>Practice &#8220;rooming in&#8221; &#8211; allow mothers and infants to remain together 24 hours a day<\/li>\n<li>Families will be encouraged to feed their babies when the baby exhibits feeding cues, regardless of feeding methods<\/li>\n<li>Give no pacifiers or artificial nipples to breastfeeding infants<\/li>\n<li>Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge<\/li>\n<\/ol>\n<\/div>\n<div id=\"frm_field_1433_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">High 5 Practice 1 &#8211; affirmation and updates<\/h3>\r\n<div id=\"frm_desc_field_ndwdz\" class=\"frm_description frm_section_spacing\"><strong>High 5 for Mom &#038; Baby Practice 1: <em>Facility will have a written maternity care and infant feeding policy addressing the High 5 for Mom &#038; Baby practices supporting breastfeeding.<\/em><\/strong> Please complete the following questions relating to policy support in your facility:<\/div>\r\n\r\n<div id=\"frm_field_1435_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first vertical_radio\">\r\n\t<div  id=\"field_3kyu9_label\" class=\"frm_primary_label\">Practice 1: Does facility policy support all 10 High 5 for Mom &#038; Baby practices?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_3kyu9_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1435-1433-0\">\t\t\t<label  for=\"field_3kyu9-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1435]\" id=\"field_3kyu9-0\" value=\"Yes\"\n\t\t data-sectionid=\"1433\"  data-invmsg=\"Practice 1: Does facility policy support all 10 High 5 for Mom &amp; Baby practices? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1435-1433-1\">\t\t\t<label  for=\"field_3kyu9-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1435]\" id=\"field_3kyu9-1\" value=\"No\"\n\t\t data-sectionid=\"1433\"  data-invmsg=\"Practice 1: Does facility policy support all 10 High 5 for Mom &amp; Baby practices? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_3kyu9\">If &#8216;No&#8217;, please comment in the following field.<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1436_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_izfqe\" id=\"field_izfqe_label\" class=\"frm_primary_label\">Policy support comments\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[1436]\" id=\"field_izfqe\" rows=\"3\"  data-sectionid=\"1433\"  data-invmsg=\"Policy support comments is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_izfqe\"><\/textarea>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_izfqe\">If you answered &#8216;No&#8217; in the previous question, please comment\/provide additional information here. <em>Note: for <strong>High 5 for Mom &#038; Baby Premier<\/strong>, policy should support all ten practices; <strong>High 5 for Mom &#038; Baby<\/strong> facility policies should support at least 5 practices.<\/em><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1438_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first vertical_radio\">\r\n\t<div  id=\"field_dvd7r_label\" class=\"frm_primary_label\">Do all policies from all departments in the facility support the Maternity Care and Infant Feeding policies?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_dvd7r_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1438-1433-0\">\t\t\t<label  for=\"field_dvd7r-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1438]\" id=\"field_dvd7r-0\" value=\"Yes\"\n\t\t data-sectionid=\"1433\"  data-reqmsg=\"Do all policies from all departments in the facility support the Maternity Care and Infant Feeding policies? cannot be blank.\" data-invmsg=\"Do all policies from all departments in the facility support the Maternity Care and Infant Feeding policies? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1438-1433-1\">\t\t\t<label  for=\"field_dvd7r-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1438]\" id=\"field_dvd7r-1\" value=\"No\"\n\t\t data-sectionid=\"1433\"  data-reqmsg=\"Do all policies from all departments in the facility support the Maternity Care and Infant Feeding policies? cannot be blank.\" data-invmsg=\"Do all policies from all departments in the facility support the Maternity Care and Infant Feeding policies? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1439_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_qj0c\" id=\"field_qj0c_label\" class=\"frm_primary_label\">Name of person responsible for reviewing maternity care and other department policy\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_qj0c\" name=\"item_meta[1439]\" value=\"\"  data-reqmsg=\"Name of person responsible for reviewing maternity care and other department policy cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name of person responsible for reviewing maternity care and other department policy is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1440_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_od8ca\" id=\"field_od8ca_label\" class=\"frm_primary_label\">Date policy last reviewed\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_od8ca\" name=\"item_meta[1440]\" value=\"\"  data-sectionid=\"1433\"  maxlength=\"10\" data-reqmsg=\"Date policy last reviewed cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date policy last reviewed is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1568_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_wawn9\" id=\"field_wawn9_label\" class=\"frm_primary_label\">Upload changed policies, if applicable\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"hidden\"  data-sectionid=\"1433\"  data-invmsg=\"Upload changed policies, if applicable is invalid\" aria-invalid=\"false\"   name=\"item_meta[1568][]\"  value=\"\" data-frmfile=\"1568\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file1568_dropzone\" role=\"group\"  aria-describedby=\"frm_desc_field_wawn9\">\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file1568[]\" id=\"field_wawn9\"\n\t\t\t data-frmfile=\"1568\" multiple=\"multiple\"  data-sectionid=\"1433\"  data-invmsg=\"Upload changed policies, if applicable is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Upload changed policies, if applicable. Drop a file here or click to upload. Maximum file size: 67.11MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Upload changed policies, if applicable. Choose File. Maximum file size: 67.11MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 67.11MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_wawn9\">If relevant policies have been added, changed, or updated since your last renewal, please upload current copies here.<\/div>\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1441_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">High 5 Premier Practices 2 through 10<\/h3>\r\n<div id=\"frm_desc_field_ka123\" class=\"frm_description frm_section_spacing\">For each of the following High 5 Premier practices, please select Yes or No to indicate whether the practice is currently supported by facility policy, and answer any additional per-practice questions.<\/div>\r\n\r\n<div id=\"frm_field_1443_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_hxudp_label\" class=\"frm_primary_label\"><strong>Practice 2<\/strong>: Facility will maintain staff competency in lactation support\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_hxudp_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1443-1441-0\">\t\t\t<label  for=\"field_hxudp-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1443]\" id=\"field_hxudp-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 2&lt;\/strong&gt;: Facility will maintain staff competency in lactation support cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 2&lt;\/strong&gt;: Facility will maintain staff competency in lactation support is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1443-1441-1\">\t\t\t<label  for=\"field_hxudp-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1443]\" id=\"field_hxudp-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 2&lt;\/strong&gt;: Facility will maintain staff competency in lactation support cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 2&lt;\/strong&gt;: Facility will maintain staff competency in lactation support is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1444_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_eedar\" id=\"field_eedar_label\" class=\"frm_primary_label\">How are your staff trained in breastfeeding support practices?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[1444]\" id=\"field_eedar\" rows=\"3\"  data-sectionid=\"1441\"  data-reqmsg=\"How are your staff trained in breastfeeding support practices? cannot be blank.\" aria-required=\"true\" data-invmsg=\"How are your staff trained in breastfeeding support practices? is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_eedar\"><\/textarea>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_eedar\">e.g., competency\/skills-based training, skills labs, on-the-job training with certified lactation staff, etc.<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1445_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_1n88a_label\" class=\"frm_primary_label\">Does the facility employ at least one person with advanced lactation education (IBCLC, CLC or similar) as part of the staff working directly with families?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1n88a_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1445-1441-0\">\t\t\t<label  for=\"field_1n88a-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1445]\" id=\"field_1n88a-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"Does the facility employ at least one person with advanced lactation education (IBCLC, CLC or similar) as part of the staff working directly with families? cannot be blank.\" data-invmsg=\"Does the facility employ at least one person with advanced lactation education (IBCLC, CLC or similar) as part of the staff working directly with families? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1445-1441-1\">\t\t\t<label  for=\"field_1n88a-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1445]\" id=\"field_1n88a-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"Does the facility employ at least one person with advanced lactation education (IBCLC, CLC or similar) as part of the staff working directly with families? cannot be blank.\" data-invmsg=\"Does the facility employ at least one person with advanced lactation education (IBCLC, CLC or similar) as part of the staff working directly with families? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1446_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_7q7dr\" id=\"field_7q7dr_label\" class=\"frm_primary_label\">If yes, please list those staff names and certifications (IBCLC, CLC, other) here:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[1446]\" id=\"field_7q7dr\" rows=\"3\"  data-sectionid=\"1441\"  data-reqmsg=\"If yes, please list those staff names and certifications (IBCLC, CLC, other) here: cannot be blank.\" aria-required=\"true\" data-invmsg=\"If yes, please list those staff names and certifications (IBCLC, CLC, other) here: is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_7q7dr\"><\/textarea>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_7q7dr\">e.g., competency\/skills-based training, skills labs, on-the-job training with certified lactation staff, etc.<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1447_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_fhrz5_label\" class=\"frm_primary_label\"><strong>Practice 3<\/strong>: All pregnant women will receive information and instruction on breastfeeding\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_fhrz5_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1447-1441-0\">\t\t\t<label  for=\"field_fhrz5-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1447]\" id=\"field_fhrz5-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 3&lt;\/strong&gt;: All pregnant women will receive information and instruction on breastfeeding cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 3&lt;\/strong&gt;: All pregnant women will receive information and instruction on breastfeeding is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1447-1441-1\">\t\t\t<label  for=\"field_fhrz5-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1447]\" id=\"field_fhrz5-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 3&lt;\/strong&gt;: All pregnant women will receive information and instruction on breastfeeding cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 3&lt;\/strong&gt;: All pregnant women will receive information and instruction on breastfeeding is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_fhrz5\">Examples include:\r\n<ul><li>Providing families with information and resources about breastfeeding prior to arrival through their Health Care Provider (HCP), local health department, WIC clinic or local community-based organization.<\/li>\r\n<li>Collaborating with local breastfeeding coalitions or other groups in their community supporting breastfeeding families.<\/li>\r\n<li>Supporting facility employees who breastfeed by providing reasonable break time and a private, safe, free from intrusion place to express milk close to their workplace (NOT a bathroom).<\/li><\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1448_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_djqbz_label\" class=\"frm_primary_label\"><strong>Practice 4<\/strong>: Assure immediate and sustained skin-to-skin contact between mother and baby after birth.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_djqbz_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1448-1441-0\">\t\t\t<label  for=\"field_djqbz-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1448]\" id=\"field_djqbz-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 4&lt;\/strong&gt;: Assure immediate and sustained skin-to-skin contact between mother and baby after birth. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 4&lt;\/strong&gt;: Assure immediate and sustained skin-to-skin contact between mother and baby after birth. is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1448-1441-1\">\t\t\t<label  for=\"field_djqbz-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1448]\" id=\"field_djqbz-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 4&lt;\/strong&gt;: Assure immediate and sustained skin-to-skin contact between mother and baby after birth. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 4&lt;\/strong&gt;: Assure immediate and sustained skin-to-skin contact between mother and baby after birth. is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_djqbz\">Examples include:\r\n<ul><li>Placing babies skin-to-skin immediately after vaginal delivery if medically stable.<\/li>\r\n<li>Placing babies skin-to-skin as soon as both mom and baby are medically stable after a C-section delivery.<\/li>\r\n<li>Allowing babies to breastfeed before any interventions are performed, such as measurements, bath, glucose sticks, footprints and eye treatment.<\/li>\r\n<li>If mother and baby are separated after birth due to a medical condition, placing the baby skin-to-skin as soon as possible after they are stable.<\/li>\r\n<li>In all of the above circumstances, once the baby is placed in skin-to-skin contact, allowing the baby to remain there continuously until after the first feeding.<\/li><\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1449_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_a87a_label\" class=\"frm_primary_label\"><strong>Practice 5<\/strong>: All families will receive individualized infant feeding counseling.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_a87a_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1449-1441-0\">\t\t\t<label  for=\"field_a87a-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1449]\" id=\"field_a87a-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 5&lt;\/strong&gt;: All families will receive individualized infant feeding counseling. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 5&lt;\/strong&gt;: All families will receive individualized infant feeding counseling. is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1449-1441-1\">\t\t\t<label  for=\"field_a87a-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1449]\" id=\"field_a87a-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 5&lt;\/strong&gt;: All families will receive individualized infant feeding counseling. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 5&lt;\/strong&gt;: All families will receive individualized infant feeding counseling. is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_a87a\">Examples include:\r\n<ul><li>Providing breastfeeding families culturally-sensitive, inclusive instruction on feeding; including but not limited to: hunger cues, satiety cues, positioning and latch, and how to tell if baby is getting enough to eat. Parents&#8217; questions will be answered by trained staff.<\/li>\r\n<li>Ensuring formula-feeding families receive culturally-sensitive, inclusive verbal AND written instructions on proper formula preparation according to the Centers for Disease Control guidelines.<\/li>\r\n<\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1450_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_q6pt6_label\" class=\"frm_primary_label\"><strong>Practice 6<\/strong>: Give newborn infants no food or drink other than breast milk, unless medically indicated.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_q6pt6_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1450-1441-0\">\t\t\t<label  for=\"field_q6pt6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1450]\" id=\"field_q6pt6-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 6&lt;\/strong&gt;: Give newborn infants no food or drink other than breast milk, unless medically indicated. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 6&lt;\/strong&gt;: Give newborn infants no food or drink other than breast milk, unless medically indicated. is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1450-1441-1\">\t\t\t<label  for=\"field_q6pt6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1450]\" id=\"field_q6pt6-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 6&lt;\/strong&gt;: Give newborn infants no food or drink other than breast milk, unless medically indicated. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 6&lt;\/strong&gt;: Give newborn infants no food or drink other than breast milk, unless medically indicated. is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_q6pt6\">Examples include:\r\n<ul><li>Breastfed babies are given only breast milk unless ordered for a medical condition.<\/li>\r\n<li>When supplement is needed, an alternative feeding method not requiring an artificial nipple is offered first. <em>such as a cup, spoon, SNS\/tube feeder, etc.)<\/em><\/li>\r\n<li>Prior to discharge, parents are taught how to use alternative feeding methods.<\/li>\r\n<li>When supplement is necessary for a medical condition, parents are instructed on hand expression or other forms of milk expression (such as pumping).<\/li>\r\n<\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1451_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_fgfpk_label\" class=\"frm_primary_label\"><strong>Practice 7<\/strong>: Practice &#8220;rooming in&#8221; &#8211; allow mothers and infants to remain together 24 hours a day.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_fgfpk_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1451-1441-0\">\t\t\t<label  for=\"field_fgfpk-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1451]\" id=\"field_fgfpk-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 7&lt;\/strong&gt;: Practice &quot;rooming in&quot; - allow mothers and infants to remain together 24 hours a day. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 7&lt;\/strong&gt;: Practice &quot;rooming in&quot; - allow mothers and infants to remain together 24 hours a day. is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1451-1441-1\">\t\t\t<label  for=\"field_fgfpk-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1451]\" id=\"field_fgfpk-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 7&lt;\/strong&gt;: Practice &quot;rooming in&quot; - allow mothers and infants to remain together 24 hours a day. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 7&lt;\/strong&gt;: Practice &quot;rooming in&quot; - allow mothers and infants to remain together 24 hours a day. is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_fgfpk\">Examples include:\r\n<ul><li>Education regarding the benefits of rooming in is provided to all mothers.<\/li>\r\n<li>Babies stay in the room with mom 23\/24 hours per day.<\/li>\r\n<li>Routine infant care is done in the room with mother by all staff, including but not limited to, nurses, doctors and other health care providers.<\/li>\r\n<li>Parents are educated that nighttime feeding and cluster feeding are normal healthy patterns.<\/li>\r\n<li>If mother chooses not to do nighttime feedings, she is educated about the impact on milk production such as low supply or engorgement and provided with information on milk expression including hand expression.<\/li>\r\n<\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1452_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_hbldc_label\" class=\"frm_primary_label\"><strong>Practice 8<\/strong>: Families will be encouraged to feed their babies when the baby exhibits feeding cues regardless of feeding method.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_hbldc_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1452-1441-0\">\t\t\t<label  for=\"field_hbldc-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1452]\" id=\"field_hbldc-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 8&lt;\/strong&gt;: Families will be encouraged to feed their babies when the baby exhibits feeding cues regardless of feeding method. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 8&lt;\/strong&gt;: Families will be encouraged to feed their babies when the baby exhibits feeding cues regardless of feeding method. is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1452-1441-1\">\t\t\t<label  for=\"field_hbldc-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1452]\" id=\"field_hbldc-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 8&lt;\/strong&gt;: Families will be encouraged to feed their babies when the baby exhibits feeding cues regardless of feeding method. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 8&lt;\/strong&gt;: Families will be encouraged to feed their babies when the baby exhibits feeding cues regardless of feeding method. is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_hbldc\"><em>Note: the following examples apply to all families, regardless of feeding method (e.g., breastfeeding, donor milk, formula)<\/em>\r\nExamples include:\r\n<ul><li>Mothers are educated and supported on how to recognize and respond to feeding cues, regardless of feeding method.<\/li>\r\n<li>Babies have documented 8 or more feeds\/attempted feeds every 24 hours when baby exhibits feeding cues. There are no restrictions on feeding length or frequency.<\/li>\r\n<li>All families, regardless of feeding method, have documented teaching of feeding practices and recommendations.<\/li>\r\n<li>All mothers who plan to breastfeed are taught hand expression.<\/li>\r\n<li>Mothers who are separated from their infants are assisted and educated to express their milk 8 or more times per 24 hours. Expression should begin at one hour but no later than 6 hours after birth.<\/li>\r\n<\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1453_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_3vw9m_label\" class=\"frm_primary_label\"><strong>Practice 9<\/strong>: Give no pacifiers or artificial nipples to breastfeeding infants.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_3vw9m_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1453-1441-0\">\t\t\t<label  for=\"field_3vw9m-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1453]\" id=\"field_3vw9m-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 9&lt;\/strong&gt;: Give no pacifiers or artificial nipples to breastfeeding infants. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 9&lt;\/strong&gt;: Give no pacifiers or artificial nipples to breastfeeding infants. is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1453-1441-1\">\t\t\t<label  for=\"field_3vw9m-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1453]\" id=\"field_3vw9m-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 9&lt;\/strong&gt;: Give no pacifiers or artificial nipples to breastfeeding infants. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 9&lt;\/strong&gt;: Give no pacifiers or artificial nipples to breastfeeding infants. is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_3vw9m\">Examples include:\r\n<ul><li>Families and mothers are counseled on the use and risks of feeding bottles, artificial nipples and pacifiers.<\/li>\r\n<li>Pacifiers are not offered for routine care.<\/li>\r\n<li>If a pacifier is needed for a painful procedure, it is removed from parental view &#8211; such as placed in a drawer under the bassinet.<\/li>\r\n<li>Mothers are educated on the &#8220;supply and demand&#8221; principle of milk production and encouraged to feed frequently.<\/li>\r\n<li>All parents are educated to identify early hunger cues.<\/li>\r\n<\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1454_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_k4ii_label\" class=\"frm_primary_label\"><strong>Practice 10<\/strong>: Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_k4ii_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1454-1441-0\">\t\t\t<label  for=\"field_k4ii-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1454]\" id=\"field_k4ii-0\" value=\"Yes\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 10&lt;\/strong&gt;: Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 10&lt;\/strong&gt;: Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge. is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1454-1441-1\">\t\t\t<label  for=\"field_k4ii-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[1454]\" id=\"field_k4ii-1\" value=\"No\"\n\t\t data-sectionid=\"1441\"  data-reqmsg=\"&lt;strong&gt;Practice 10&lt;\/strong&gt;: Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge. cannot be blank.\" data-invmsg=\"&lt;strong&gt;Practice 10&lt;\/strong&gt;: Provide mothers options for breastfeeding support in the community (such as a telephone number, walk-in clinic information, support groups, etc.) upon discharge. is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_k4ii\">Examples include:\r\n<ul><li>Mothers are routinely referred to a support group, outpatient clinic, local lactation specialist or community resource to call for breastfeeding support after discharge.<\/li>\r\n<li>The facility has a system of follow-up support for breastfeeding mothers after discharge, such as early post-natal or lactation clinic check-ups, home visits, telephone calls.<\/li><\/ul><\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_1455_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_xnf8g\" id=\"field_xnf8g_label\" class=\"frm_primary_label\"><strong>Comments<\/strong>\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[1455]\" id=\"field_xnf8g\" rows=\"5\"  data-sectionid=\"1441\"  data-invmsg=\"&lt;strong&gt;Comments&lt;\/strong&gt; is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_xnf8g\"><\/textarea>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_xnf8g\">Any additional comments you&#8217;d like to add about any practices.<\/div>\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1423_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<button class=\"frm_save_draft\" >Save Draft<\/button>\r\n\r\n<\/div>\r\n<\/div>\n<input type=\"hidden\" name=\"item_meta[1430]\" id=\"field_dx23w\" value=\"\" data-frmval=\"\"\/>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_2386_container\">\n\t\t\t<label for=\"field_pvkbk\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_pvkbk\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[2386]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<style>.frm-abandonment-modal * {\n\tbox-sizing: border-box;\n}\n\n.frm-abandonment-modal {\n\tposition: fixed;\n\ttop: 0;\n\tright: 0;\n\tbottom: 0;\n\tleft: 0;\n\tz-index: 1000;\n\tdisplay: flex;\n\tflex-direction: column;\n\talign-items: center;\n\tvisibility: hidden;\n\toverflow: hidden;\n\topacity: 0;\n\t-webkit-overflow-scrolling: touch;\n}\n\n.frm-abandonment-modal .tingle-modal__close {\n\tdisplay: none;\n}\n\n.frm-abandonment-modal .tingle-modal-box {\n\tposition: relative;\n\tflex-shrink: 0;\n\tmargin-top: auto;\n\tmargin-bottom: auto;\n\tmax-width: 345px;\n\tbackground: #fff;\n\topacity: 1;\n\tcursor: auto;\n\tborder-radius: var(--border-radius);\n\twill-change: transform, opacity;\n\tpadding: 1.5rem;\n\tbox-shadow: 1px 1px 11px 2px rgba(0, 0, 0, 0.2);\n}\n\n.frm-abandonment-modal .tingle-modal-box__content h3{\n\tmargin-top: 0;\n}\n\na.frm-abandonment-close {\n\tposition: absolute;\n\ttop: 10px;\n\tright: 5%;\n\ttext-decoration: none;\n\tcolor: currentColor;\n\topacity: .8;\n\tfont-size: 30px;\n\tfont-weight: 300;\n\tline-height: 21px;\n}\n\n.frm-abandonment-btn-invisible {\n\topacity: 0;\n}\n\n.tingle-enabled {\n\tposition: fixed;\n\tright: 0;\n\tleft: 0;\n\toverflow: hidden;\n}\n\n.frm-abandonment-modal.tingle-modal--visible .tingle-modal-box__footer {\n\tbottom: 0;\n}\n\n.frm-abandonment-modal.tingle-modal--visible {\n\tvisibility: visible;\n\topacity: 1;\n\tbackground: rgba(0, 0, 0, 0.5);\n}\n\n.frm-abandonment-modal.tingle-modal--visible .tingle-modal-box {\n\tanimation: abdn-scale .2s cubic-bezier(.68, -.55, .265, 1.55) forwards;\n}\n\n.tingle-modal--overflow {\n\toverflow-y: scroll;\n\tpadding-top: 8px;\n}\n\n@keyframes abdn-scale {\n\t0% {\n\t\topacity: 0;\n\t\ttransform: scale(.9);\n\t}\n\t100% {\n\t\topacity: 1;\n\t\ttransform: scale(1);\n\t}\n}<\/style><input type=\"hidden\" name=\"current_page\" value=\"7116\"\/><input type=\"hidden\" name=\"frm_saving_draft\" class=\"frm_saving_draft\" value=\"\" \/><input name=\"frm_state\" type=\"hidden\" value=\"POF2lgysRadg1h9oEVAVrbTaH+d0QIKxy\/VpIOisdSzfG7AddA7zkbqvhQy6ufYB\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Kansas Hospitals and Birth Centers: use this streamlined online form to apply for renewal of recognition as a High 5 for Mom &amp; Baby Premier facility. If helpful, you can download an offline sample to gather the information to enter into the official online form below. If you have questions about High 5 for Mom &#8230;<\/p>\n","protected":false},"author":3,"featured_media":3938,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-contact-hi5.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-7116","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages\/7116","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/comments?post=7116"}],"version-history":[{"count":9,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages\/7116\/revisions"}],"predecessor-version":[{"id":8871,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/pages\/7116\/revisions\/8871"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/media\/3938"}],"wp:attachment":[{"href":"https:\/\/healthfund.org\/a\/wp-json\/wp\/v2\/media?parent=7116"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}