This form is a sample letter in Word format covering the subject matter of the title of the form.
Puerto Rico Facsimile Cover Sheet
Category:
State:
Multi-State
Control #:
US-0021LTR
Format:
Word;
Rich Text
Instant download
Description
How to fill out Facsimile Cover Sheet?
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FAQ
What Needs to be Included on a HIPAA Fax Cover Sheet? Date and Time Fax sent. Receiver name and fax # Sender name, organization, and phone # Patients Name and reference # (if applicable) HIPAA Fax Disclaimer.
Use a HIPAA Fax Disclaimer Every time you fax a document containing PHI, you are required by HIPAA to use a fax disclaimer with the approved statement warning against unauthorized access.
Use specific language, like ?This fax contains confidential information intended solely for the individual or entity named above. Unauthorized disclosure, copying, or distribution is prohibited.? Place this fax cover sheet confidentiality statement in a prominent place.
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.
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.
Regardless of why you are faxing, you need to include a fax cover sheet, so your fax message gets to the intended recipient. To make things easy, we have created a fax cover sheet template, so all you have to do is print it, fill it out, and fax away.
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.
Your HIPAA cover sheet should include the following: The date and time the fax was transmitted. The receiver's name and fax number. The sender's name and fax number.
