HIPAA Compliant Fax Cover Sheet

To protect a patient's sensitive health reports it is important to use a HIPAA Compliant Fax Cover Sheet while faxing the documents. There is not any direct mention of using a fax cover sheet but not using one can lead to the violation of other mentioned rules

A HIPAA Compliant Fax Cover Sheet should contain the following:

  • HIPAA Fax Disclaimer

The disclaimer notifies the receiver that the fax contains Protected Health Information or PHI/ePHI. An ePHI is just PHI but it's stored digitally. HIPAA defines PHI as an individual's health information. And, to be specific if it contains one of the 18 listed identifiers. So, any person who gets hold of such documents or information is legally responsible for its disclosure. Here is a sample disclaimer that can be used on the cover sheet


The information contained within these documents is protected under the federal Health Insurance Portability & Accountability Act (HIPAA) privacy rule. And it’s intended for the addressed individual. Additionally, the documents may contain private and sensitive information that should not be disclosed or shared under any circumstances.

If you have received this by accident, you must contact the sender’s number and discuss the return process. Additionally, any damages to the documents may result in legal action.

  • Date and Time of sent Fax

You can also include the date and time on the cover sheet. It clarifies when the information was sent. And whether an immediate response is needed.

  • Fax number

It is better to add both sender's and receiver's fax numbers. It's a good precaution in case the documents are sent accidentally to another department or individual. Also, you should recheck if the fax numbers are correct or not.

  • Contact Details

The fax cover sheet should also contain the address of both the sender and recipient. Because the sender's or the return address is helpful in case of any difficulty. You should also include the name, and contact number of both the sender and the receiver.

  • Follow-up Number

It's also better to add a follow-up number. The receiver can use it to verify whether the fax It will also be helpful if the documents are accidentally sent to an unintended person.

Also, you should be aware of the following safety checkpoints:

  • Verify both the sender's and receiver's fax numbers
  • Make sure that the Fax machine is in a secure place
  • You should also inform the recipient prior to sending the documents. It's also a good safety measure
  • The cover sheet should contain a notice that conveys the importance of the documents and their implications in case of any wrongful disclosure.

Furthermore, the actions mentioned below can lead to legal action against you

  • Disclosure or Wrongful access to PHI
  • Acquiring PHI using a false claim
  • Utilizing PHI for profit

In conclusion, using a HIPAA compliant fax cover sheet helps protect a patient's confidential medical reports.