HIPAA Gastroenterology Fax Cover Sheet

FAX

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

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

Urgent
For Review
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 Name],

Please find attached the referral letter and relevant patient records for [Patient's Full Name], including their most recent laboratory test results and imaging studies pertinent to their ongoing gastroenterological condition. We are seeking your expertise in evaluating their condition for a potential colonoscopy. Your timely feedback and recommendations would be highly appreciated to proceed with the best care plan for the patient.

Thank you for your attention to this matter. Please confirm receipt of these documents and do not hesitate to contact me directly for any further information or discussion regarding the patient's care.

Best Regards,

[YOUR NAME]