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 New York
Category:
State:
Multi-State
Control #:
US-0021LTR
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
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 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.
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 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.
What is Included on a Fax Cover Sheet? From: (your name). Fax: (your fax number). Phone: (your phone number). To: (the company or person who is receiving the fax message). Attn: (the specific person who needs to get the fax). Fax: (their fax number). Phone: (their phone number).
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 compliant fax cover sheet should include sender and recipient details, date and time, a confidentiality statement, privacy notice, subject, page count, and optional disclaimers.
To maintain HIPAA compliance with any faxes sent or received, you need to take the following three measures: Use a cover sheet. Create an audit trail. Verify the correct recipient.
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.
