What to Include in a HIPAA Fax Cover Sheet? 

A HIPAA fax cover sheet should list sender/receiver information, date and time, page count, patient reference and a concise privacy disclaimer instructing unintended recipients to destroy the fax. Skipping any field can lead to fines of up to $50,000 per violation—avoid this risk easily downloading a HIPAA Fax Cover Sheet and send it with Fax.Plus HIPAA plan

Why a HIPAA Cover Sheet Is Non-Negotiable

The Health Insurance Portability and Accountability Act (HIPAA) protects patient health information (PHI) from unauthorized access. When sending faxes, a HIPAA-compliant cover sheet ensures confidential patient details stay protected. Not using a proper cover sheet risks exposing sensitive information.

In 2022, healthcare providers faced significant penalties due to improperly protected faxes. One medical office was fined $40,000 after accidentally faxing patient records without the required cover sheet. These costly mistakes underscore the importance of compliance.

Traditional paper faxes can easily be misplaced or intercepted. Online fax solutions like Fax.Plus reduce these risks by securely transmitting documents with encrypted connections.

Mandatory Fields Checklist

  • Sender Details: Always clearly state your full name, organization name, phone, and fax number.

  • Receiver Details: Clearly list the recipient's name, organization, and correct fax number.

  • Date & Time Stamp: Include the date and time when the fax is sent to maintain accurate records and audit trails.

  • Total Page Count: Indicate the number of pages, including the cover sheet, to help recipients verify completeness.

  • Patient Name or Reference Number (where applicable): Mentioning the patient’s name or a unique identifier helps the receiver quickly organize and securely store information.

  • HIPAA Disclaimer: Always include a clear statement explaining the confidential nature of the information and instructions for unintended recipients.

Crafting the HIPAA Disclaimer

Your HIPAA disclaimer should emphasize confidentiality, refer explicitly to PHI (Protected Health Information), and instruct accidental recipients to destroy the fax immediately.

Keep disclaimers concise and clear—ideally under 120 words—to ensure readability and compliance.

Sample Short Disclaimer (Copy-Paste)

This fax contains confidential and legally protected health information intended solely for the named recipient. If you have received this fax in error, notify us immediately and securely destroy this document. Unauthorized viewing, copying, or distribution is strictly prohibited.

Sample Extended Disclaimer

This communication contains Protected Health Information intended only for the listed recipients. If you received this transmission in error, please contact the sender immediately at the provided number. You must securely destroy the fax without retaining any copies or sharing it with unauthorized individuals.


Looking to send sensitive documents securely? Use one of our HIPAA-compliant cover sheets to help protect patient privacy and support your compliance efforts.

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