Printable Fax Cover Sheet With Confidentiality Statement In Utah
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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.
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.
There is no official HIPAA cover sheet but the cover sheet should contain the following information to be considered HIPAA compliant: Date and Time Fax sent. Receiver name and fax #
The confidentiality notice should always appear on the fax's cover sheet, along with a notice of the intended recipients, their contact information, and the contact information of the sender. It is highly recommended that the word “confidential” appear prominently (in large type) on the cover page.
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.
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.
