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 Kings
Category:
State:
Multi-State
County:
Kings
Control #:
US-0021LTR
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
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.
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.
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 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.
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.
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.
