Positive Pathways LLC

Effective: October 1, 2017

This notice describes how your child’s medical information may be used and disclosed (provided to others) and how you can get access to this information. Please review this notice carefully.

Our goal at Positive Pathways is to take appropriate steps to attempt to safeguard any medical or other personal information that is provided to us. The Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires us to: (i) maintain the privacy of medical information provided to us; (ii) provide notice of our legal duties and privacy practices; and (iii) abide by the terms of our Notice of Privacy Practices currently in effect.

WHO WILL FOLLOW THIS NOTICE: This notice describes the practices of Positive Pathway’s employees and staff. This notice applies to each of these individuals, entities, sites and locations. In addition, these individuals, entities, sites and locations may share medical and other private information with each other for the treatment, payment and health care operation purposes described in this notice. 

Positive Pathways understands that we collect private and/or potentially sensitive medical information about each child and/or the child’s family. We call this information Protected Health Information (PHI). In order to maintain HIPAA compliant, we work on a “need to know” basis. This notice explains the child’s privacy rights and addresses how Positive Pathways may use and disclose protected health information.


  • Maintain the privacy of your child’s health information as required by law.
  • Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about your child.
  • Abide by the terms of this Notice.
  • Notify you if we cannot accommodate a requested restriction or request; and, HIPAA Privacy Notice.
  • Accommodate your reasonable requests regarding methods to communicate health information with you.


In the ordinary course of receiving treatment and health care services from us, you will be providing us with some or all of your child’s information such as: 

  • Name, address, email, and phone number.
  • Date of Birth.
  • Social Security Number.
  • Your insurance information and coverage.
  • Service start and end date.
  • Information concerning your child’s doctor, nurse, or other medical providers.
  • Information relating to your child’s medical history.
  • Information concerning your family members’ medical history.

In addition, we will gather certain medical information about your child and will create a record of the care provided to you. Some information also may be provided to us by other individuals or organizations that are part of your “circle of care”- such as the referring physician or agency, your other doctors, your health plan, and close friends or family members.


We may use and disclose personal and identifiable health information about your child for a variety of purposes. All of the types of uses and disclosures of information are described below, but not every use or disclosure in a category is listed. 

Required Disclosures: We are required to disclose health information about your child to the Secretary of Health and Human Services, upon request, to determine our compliance with HIPAA and to you, in accordance with your right to access and right to receive an accounting of disclosures, as described below.

For Treatment: We may use health information about your child during treatment. For example:

  • We may use your child’s medication history, such as prescription drugs, to assess the effectiveness of therapy. A behavior analyst may use your child’s health information to provide services.
  • A behavior analyst may obtain treatment information about your child and record it in your client file.
  • During the course of your child’s treatment, the behavior analyst may need to consult with other professionals or individuals (e.g., physicians, social workers, educators, family members etc.,) involved in your child’s medical care or treatment. He/she will obtain authorization to share your child’s personal information with these individuals.
  • Your child’s health information may be shared with other clinical staff in the company for additional support in developing your treatment program.

For Payment: We may use and disclose health information about clients to bill for our services and to collect payment from you or your insurance. For example, we may need to give a payer information about your child’s current medical condition so that they will pay us for the services that we have provided. We may also need to inform your payer of the treatment your child is going to receive in order to obtain prior approval or to determine whether the service is covered.

For Health Care and Business Operations: We may use and disclose information about your child for the general operation of our business. For example, Positive Pathways may use and disclose the client’s protected health information in order to maintain necessary administrative, education, quality assurance, and business functions. We may also use PHI about clients to help us evaluate what additional services to offer, how we can improve efficiency, or the effectiveness of certain treatments. We sometimes arrange for auditors or other consultants to review our practices, evaluate our operations, and tell us how to improve our services. Or, for example, we may use and disclose your health or other personal information to review the quality of services provided to clients.

Satisfactory Surveys: Though Positive Pathways does ask our client’s representative to participate in satisfactory surveys, all are completed anonymously and no PHI is disclosed during the survey.


There are a number of public policy reasons why we may disclose information about your child, which are described below: 

  1. We may disclose health and other private information about your child when we are required to do so by federal, state, or local law, including but not limited to: Abuse, neglect, domestic violence, response to a warrant, subpoena, or other order of a court or administrative hearing body.
  2. We may provide client’s PHI to individuals such as the client’s family members, caregivers, and friends, who are involved in the client’s treatment or who help pay for the client’s treatment. We may do this only with explicit written approval from the guardian, which informs us that we have their consent to do so.
  3. We may also disclose a client’s PHI to a person who may have been exposed to a communicable disease or to an employer to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether an individual has a work-related illness or injury.
  4. We may disclose PHI about your child in connection with certain health oversight activities of licensing and other health oversight agencies which are authorized by law. Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, or administrative proceedings or actions.
  5. PHI about your child may be disclosed when necessary to prevent a serious threat to you, or your child’s health and safety, or the health and safety of others.

Our Business Associates: Law requires all our business associates to follow the same privacy laws that we are. Examples of our business associates are funding sources and insurance carriers.

Disclosures to Persons Assisting in Your Child’s Care or Payment for Care: We may disclose information to individuals involved in your child’s care or in the payment for your care. This includes people and organizations that are part of your “circle of care” — such as your spouse, your other doctors, Insurance claim providers, or an aide who may be providing services to your child. We may also use and disclose PHI about a client for disaster relief efforts and to notify persons responsible for a client’s care about a client’s location, general condition, or death. Generally, we will obtain your verbal and/or written agreement before using or disclosing PHI in this way.

Appointment Reminders: We may use and disclose PHI to contact you as a reminder that your child has an appointment or that you should schedule an appointment


You have the right to ask for restrictions on the ways we use and disclose your child’s PHI for treatment, payment and health care operation purposes. You may also request that we limit our disclosures to persons assisting your care or payment for your child’s care. We will consider your request, but we are not required to accept it. Any time Positive Pathways agrees to a restriction, it must be in writing and signed by the Executive Director or his/her designee.

You have the right to request that you receive communications containing your child’s PHI from us by alternative means or at alternative locations. For example, you may ask that we only contact you at home or by mail.

Other than for the range of purposes previously identified in this notice, we will not use or disclose your child’s PHI for any purpose unless you provide us with specific written authorization to do so. If you grant us authorization, you can still withdraw this authorization at any time, though the authorization must be revoked in writing. In order to withdraw the authorization, mail, email, or fax the revocation to Michelle “Shelly” Wold, at Positive Pathways, 2529 24th St, San Francisco, CA 94110; email: [email protected]; fax: (415) 520-6530. If you revoke the authorization, we will discontinue the use or disclosure of your child’s PHI to the extent that we relied on his/her authorization for the use/disclosure. However, we cannot take back or undo any use/disclosure made under your grant of authorization prior to our receipt of your written revocation of that authorization, and we must continue any use/disclosure that is necessary in keeping records of your child’s treatment.

Except under certain circumstances, you have the right to inspect and copy medical, billing and other records used to make decisions about your child.

If you believe that information in your child’s records is incorrect or incomplete, you have the right to ask us to correct the existing information or add missing information. Under certain circumstances, we may deny your request, such as when the information is accurate and complete. When making a request for an amendment, you must state a reason for making the request in writing.

You have a right to receive a list of certain instances when we have used or disclosed your child’s PHI such as, requested by federal, state, or local, safety for others, yourself, or your child.

We are not required to include in the list uses and disclosures for your treatment, payment for services furnished to you, our health care operations, disclosures to you, disclosures you give us authorization to make, uses and disclosures during the time our services are provided to your child.

If someone else needs your PHI, you may be asked to sign a PHI Release Form if:

  • We need your permission to provide services or care.
  • You want us to send your child’s PHI to another agency or provider for reasons not allowed by law without your permission.
  • You want PHI sent to someone else, such as your attorney, a relative or other representative.
  • Your permission to share your child’s PHI is good until the end date you put on the form. We can only share the PHI you list. You may cancel or change this permission by contacting Positive pathways.

You have the right to a copy of this notice in paper form. You may ask us for a copy at any time.

To exercise any of your rights, please contact our Executive Director and Security Officer, Michelle “Shelly” Wold, at [email protected]; mail: 2529 24th St, San Francisco, CA 94110.


A breach is the use or disclosure of your child’s PHI that is not permitted under HIPAA, including loss by theft, mistake or hacking. We will notify you by email or mail if there is a breach of your child’s PHI under HIPAA.


In the event that Positive Pathways experiences a breach of PHI, Positive Pathways will automatically notify all those affected in writing, either by mail or email, and follow HIPAA procedures regarding the breach. 


We are required to comply with this notice. We reserve the right to make changes to this notice at any time. We reserve the right to make the revised notice effective for PHI we have about you as well as any information we receive in the future. In the event there is a material change to this notice, the revised notice will be provided on our website and by mail or email. In addition, you may request a copy of the revised notice at any time. 


If you have any complaints concerning our privacy practices, you may contact the U.S. Department of Health & Human Services at:

200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free Call Center: 1-800-368-1019

Or contact Positive Pathways’ Executive Director and Security Officer, Michelle “Shelly” Wold, at [email protected]; mail: 2529 24th St, San Francisco, CA 94110.


To obtain more information concerning this notice, you may also contact: Michelle “Shelly” Wold, at [email protected]


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Last updated: August 2018