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 Harris
Category:
State:
Multi-State
County:
Harris
Control #:
US-0021LTR
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
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.
To ensure HIPAA compliance, you will need a cloud fax service that will sign Business Associate Agreement (BAA) to ensure proper handling of all information to prevent access by unauthorized parties. This agreement is a requirement perHITECH and must be a feature of any online fax service you choose.
As Contained in the HHS HIPAA Rules. HHS Regulations as Amended January 2013. General Provisions: Definitions - Disclosure - § 160.103. Disclosure means the release, transfer, provision of access to, or divulging in any manner of information outside the entity holding the 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 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.
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.
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 fax cover sheet typically has basic contact information: who the fax is going to, who the fax is from, the subject matter, how many pages are included, company name (address is optional), a telephone number, and a check box to mark whether it's urgent or needs a reply.
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. The information contained in this facsimile transmission is privileged and confidential and is intended only for the use of the recipient listed above. Complete all information on the form. The HIPAA Notice of Confidentiality must appear on the top of the fax transmission cover sheet: Enter on the fax cover sheet: "CONFIDENTIAL". A fax cover sheet includes a 'Confidential' notice, indicating that the fax is meant solely for the designated recipient. BW9-2, Request for Omission.
