Whether sending a fax to another provider, a patient, or a business associate who needs it, always use a cover sheet. Do not put confidential information (PHI) on the cover sheet. Only send a fax to someone expecting it and who is waiting for it. Make sure to include a HIPAA fax disclaimer.

Sample 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.  It may contain information that is proprietary, privileged, confidential and/or exempt from disclosure under applicable law.  If you are not 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 destruction of the information and all copies.


The fax cover sheet should include:

*date and time sent

*name of recipient

*sender’s name and organization

*sender’s phone number

*HIPAA fax disclaimer


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