This form is a sample letter in Word format covering the subject matter of the title of the form.
Fax Cover Sheet With Confidentiality Statement In Wake
Category:
State:
Multi-State
County:
Wake
Control #:
US-0021LTR
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
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.
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 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.
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.
For example, you may not include the patient's name as this violates HIPAA standards. Instead, a fax cover sheet may have the patient's case number for easy reference. In some cases, you may include the physician's contact number, case number, and insurance policy number on the fax cover sheet.
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.
More info
Confidentiality statement: Position the confidentiality statement near the bottom of the cover sheet or in a footer. Place this fax cover sheet confidentiality statement in a prominent place.For example, you can put it near the bottom of the cover sheet or in a footer. Use short, descriptive labels to convey the information. A fax cover sheet includes a 'Confidential' notice, indicating that the fax is meant solely for the designated recipient. The information contained in this facsimile transmission is privileged and confidential and is intended only for the use of the recipient listed above. Download free editable PDF fax cover sheets with confidentiality statements and disclaimers: formal, professional and casual. Confidentiality Statement. Thank you for your interest in the Wake County Public School System. I'm going to give you examples of what your cover sheets could look like and what they could contain.
