This is an official Washington court form for use in civil cases, a Case Information Cover Sheet for Superior Courts.
Case Information Cover Sheet With Hipaa Statement
Category:
State:
Washington
Control #:
WA-0781-08
Format:
Word;
PDF;
Rich Text
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Description
How to fill out Washington Cover Sheet - Case Information Cover Sheet For Superior Courts?
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Example of a HIPPA email disclaimer: This email may contain health information that is protected by law. Although (Your Company) is fully compliant with all regulations for the protection of our patients' health information, no email is completely secure. We urge you not to include personal data in emails.
Both physical and digital faxes require cover sheets if they contain PHI. The information on the sheet is essential to alert the receiver of the private nature of the faxed document.
NOTICE: This e-mail message is confidential and may be legally privileged. If you are not the intended recipient, you are hereby notified that any review, copying, forwarding, retention, dissemination, distribution, or disclosure of this communication 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.
I hereby authorize use or disclosure of protected health information about me as described below. I understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons or facility receiving it, and would then no longer be protected by federal privacy regulations.