HIPAA Chiropractic Fax Cover Sheet

FAX

To:
Name: [Recipient's Name]
Title: [Recipient's Title]
Fax Number: [Recipient's Fax Number]
Phone Number: [Recipient's Phone Number]

From:
Name: [Your Name]
Title: [Your Title]
Fax Number: [Your Fax Number]
Phone Number: [Your Company Number]

Urgent
For Review
Please Respond

Message

Dear [Recipient's Name],

Please find attached the requested patient records for Jane Smith, including their most recent chiropractic treatment summaries and diagnostic reports. These documents are being sent in response to your referral request dated April 8, 2050, to coordinate the patient's ongoing care.

Should you require any additional information or clarification regarding these documents, please do not hesitate to contact me directly at [Your Company Number]. Your prompt review and feedback would be greatly appreciated to ensure seamless continuity of care for our mutual patient.

Thank you for your attention to this matter.

Sincerely,

[Your Name]
[Your Title]
[Your Contact Number]