Technical support & sales support, Sample reception desk notice to clients, Patient consent form for medical (hipaa) – CTL Confirm-IT2 User Manual
Page 38
Additional Information
Confirm-IT2 User Guide
34
Sample Reception Desk Notice To Clients
The last page of this manual contains a sample notice for the clients to read when visiting
the business where Confirm-IT2 is installed. The “NOTICE TO OUR CLIENTS explains
the new appointment reminder feature and requests their feedback or any special
reminder related requests.
It is suggested that this sample or one similar be placed in plain view where the clients
can see it.
Patient Consent Form for Medical (HIPAA)
If the Confirm-IT2 Medical application is installed to remind patients of their
appointments, a Health Insurance Portability and Accountability Act (HIPAA) consent
form must be signed by each patient for permission to send automated appointment
reminders. A copy of a sample form is included in Appendix A of this manual. Paragraph
2 of this form pertains to appointment reminders to patients. It is the responsibility of the
medical service provider to have a signed HIPAA consent form for each patient entered
in the Confirm-IT2 database. CTL, Inc. will not be responsible for any HIPAA
violations.
Technical Support & Sales Support
Visit
for the latest technical update information. Technical Support
questions should be addressed to the company that installed your Confirm-IT2 system.
CTL Inc. 375 Bridgeport Ave Shelton, CT 06484 203-925-4266