Privacy & Policy

HIPAA Consent for Treatment and Limits of Liability

The Health Insurance Portability and Accountability Act (HIPAA) establishes patient rights and protections 

associated with the use of protected health information. HIPAA provides patient protections related to the 

electronic transmission of data (“the transaction rules”), the keeping and use of patient records (“privacy rules”), 

and storage and access to health care records (“the security rules”). HIPAA applies to all health care providers, 

including mental health care providers. Providers and health care agencies are required to provide patients a 

notification of their privacy rights as it relates to their health care records.

This Patient Notification of Privacy Rights informs you of your rights. Please carefully read this Patient 

Notification. It is important that you know and understand the patient protections HIPAA affords you as a 

patient. In mental health care, confidentiality and privacy are central to the success of the therapeutic 

relationship; therefore, we will do all we can do to protect the privacy of your mental health records. Please 

contact your counselor if you have questions regarding matters discussed in this Patient Notification.

Detailed information may be found at

Limits of Services and Assumption of Risks: Therapy sessions carry both benefits and risks. Therapy sessions 

can significantly reduce the amount of distress someone is feeling, improve relationships, and/or resolve other 

specific issues. However, these improvements and any “cures” cannot be guaranteed for any condition due to 

the many variables that affect these therapy sessions. Experiencing uncomfortable feelings, discussing 

unpleasant situations and/or aspects of your life are considered risks of therapy sessions.

Limits of Confidentiality: What you discuss during your therapy session is kept confidential. No contents of the 

therapy sessions, whether verbal or written may be shared with another party without your written consent or 

the written consent of your legal guardian.

The following is a list of exceptions:

Duty to Warn and Protect If you disclose a plan or threat to harm yourself, the therapist must attempt to notify 

your family and notify legal authorities. In addition, if you disclose a plan to threaten or harm another person, the

therapist is required to warn the possible victim and notify legal authorities.

Abuse of Children and Vulnerable Adults If you disclose, or it is suspected, that there is abuse or harmful neglect 

of children or vulnerable adults (i.e. the elderly, disabled/incompetent), the therapist must report this information 

to the appropriate state agency and/or legal authorities.

Prenatal Exposure to Controlled Substances Therapists must report any admitted prenatal exposure to 

controlled substances that could be harmful to the mother or the child.

Minors/Guardianship Parents or legal guardians of non-emancipated minor clients have the right to access the 

clients’ records.

Insurance Providers, Insurance companies, and other third-party payers

Insurance Providers, Insurance companies, and other third-party payers are given information that they request 

regarding services to the clients. The type of information that may be requested includes types of service, 

dates/times of service, diagnosis, treatment plan, description of impairment, the progress of therapy, case notes, 

summaries, etc.

Detailed information may be found at

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We are expanding our services by offering webinars, workshops, and other personal growth events.

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Maria Giuliana, LMHC, US  Navy Veteran, (She/Her) 

3955 Riverside Ave
Jacksonville, FL 32205
United States

(904)549-6786 Office

(904) 571-8413 Mobile

(904) 990-1366 Fax

[email protected]