Printable Fax Cover Sheet With Confidentiality Statement In Harris
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The information is intended only for the use of the individual(s) or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or taking of any action in reliance on the contents of this facsimile information is strictly prohibited.
A HIPAA fax cover sheet disclaimer is a message addressed to the fax recipient, that states that the faxed information is confidential. The disclaimer also should state that the transmission may contain protected health information.
Some of the top items that need to be included in a HIPAA fax cover sheet are: A confidentiality statement: This statement explains that the information being faxed is confidential and should not be read by anyone other than the intended party.
A HIPAA compliant fax cover sheet should include sender and recipient details, date and time, a confidentiality statement, privacy notice, subject, page count, and optional disclaimers.
A HIPAA fax cover sheet disclaimer. A HIPAA fax cover sheet disclaimer is a message addressed to the fax recipient, that states that the faxed information is confidential. The disclaimer also should state that the transmission may contain protected health information.
The information is intended only for the use of the individual(s) or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or taking of any action in reliance on the contents of this facsimile information is strictly prohibited.
The confidentiality notice should clearly state that the fax may contain information protected by law and should therefore only be viewed by the intended recipients listed on the cover page. It is usually not necessary to specify the specific law in question (e.g. HIPAA).
Tip: If you're already in Word for the web, get to the fax templates by going to File > New, and then below the template images click More on Office. You'll be on the Templates for Word page. In the list of categories, click Fax Covers. To print the fax cover sheet, press Ctrl+P, and wait for the Print dialog.
An example of a fax disclaimer statement: If you are not the intended recipient, please be advised that any disclosure, copying, distribution, or use of the contents of this information is strictly prohibited, and that any misdirected or improperly received information must be returned to this company immediately.
The best practice for filling out a fax cover sheet includes, complete sender and recipient information, detailed fax information, confidentiality notice, clear and concise communication, and a consistent format.
