Free HIPAA Dermatology Fax Cover Sheet Template
HIPAA Dermatology Fax Cover Sheet
FAX |
TO:
Name: [Recipient's Name]
Title: [Recipient's Title]
Fax: [Recipient's Fax Number]
Phone: [Recipient's Phone Number]
FROM:
Name: [YOUR Name]
Title: [Your Position]
Fax: [Your Fax Number]
Phone: [Your Company Number]
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Urgent
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For Review
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Please Respond
Message
This fax contains legally privileged health information for the specified individual or entity. Any unauthorized use is strictly prohibited. If received incorrectly, contact the sender for return or destruction.
Dear [Recipient's Name],
Enclosed, please find the updated medical records and biopsy results for our mutual patient, John Doe, who was seen at Sunrise Dermatology Clinic on March 1, 2050. Given the urgency of the findings, we request your expert review and advice on a treatment plan. We believe a collaborative approach will ensure the best possible outcome for Mr. Doe's condition.
Please review the attached documents and provide your recommendations at your earliest convenience. Should you need further information or wish to discuss the case directly, do not hesitate to contact me.
Thank you for your prompt attention to this matter.
Kind Regards,
[YOUR NAME]
[YOUR COMPANY NAME]
[YOUR EMAIL]
