Free blank fax coversheets

A coversheet on a fax is critical for privacy and security of ePHI: Electronic Personal Health Information as well as to make sure the end reciever knows what they are seeing. We have included two examples here. A HIPAA version which contains a generic HIPAA disclaimer and a "Business-class" coverpage that has a standard disclaimer.

HIPAA Coversheet Example

There is no official HIPAA cover sheet but the cover sheet should contain the following information to be considered HIPAA compliant:

  • Date and Time Fax sent
  • Receiver name and fax #
  • Sender name, organization and phone #
  • Patients Name and reference # (if applicable)
  • HIPAA Fax Disclaimer

An example of a HIPAA Fax disclaimer:

IMPORTANT: This facsimile transmission contains confidential information, some or all of which may be protected health information as defined by the federal Health Insurance Portability & Accountability Act (HIPAA) Privacy Rule. This transmission is intended for the exclusive use of the individual or entity to whom it is addressed and may contain information that is proprietary, privileged, confidential and/or exempt from disclosure under applicable law.

If you are not the intended recipient (or an employee or agent responsible for delivering this facsimile transmission to the intended recipient), you are hereby notified that any disclosure, dissemination, distribution or copying of this information is strictly prohibited and may be subject to legal restriction or sanction. Please notify the sender by telephone (number listed above) to arrange the return or destruction of the information and all copies.

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A coversheet on a fax is critical for privacy and security of ePHI: Electronic Personal Health Information as well as to make sure the end reciever knows what they are seeing. We have included two examples here. A HIPAA version which contains a generic HIPAA disclaimer and a "Business-class" coverpage that has a standard disclaimer.

Business Coversheet Example

Just replace the logo with your logo and you can make this coverpage yours. If you need HIPAA Compliant cloud fax or Enterprise business class cloud fax services then check out our business class fax service pricing.