ROWAN UNIVERSITY POLICY
Title: Fax Machine Transmittal of Confidential, Sensitive or Protected Health Information (PHI)
Subject: Office of Compliance & Corporate Integrity (OCCI)
Policy No: OCCI: 2013: P13
Applies: RowanSOM
Issuing Authority: Rowan President & RowanSOM Dean
Responsible Authority: RowanSOM Chief Compliance and Privacy Officer & RowanSOM Chief Information Officer
Adopted: Jan 23, 2003
Reviewed: Oct 24, 2011
Amended: July 1, 2013
Last Reviewed: Jan 6, 2014
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ATTACHMENT 1
CONFIDENTIAL FAX COVER SHEET
“Confidential Protected Health and Other Information Enclosed” Protected Health Information is personal and sensitive information related to a person’s health care. The other protected information may include information protected by State or Federal regulations and University policy. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Re-disclosure without additional patient consent or as permitted by law is prohibited. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to penalties described in federal and state law. |
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To: From:
Location: Location:
Date Sent: Fax Number:
Time Sent: Phone Number:
Fax Number: To: From:
Location: Location:
Date Sent: Fax Number:
Time Sent: Phone Number:
Fax Number: Number of Pages (including cover):
Phone Number:? Urgent ? For Review ? As Requested ? Please Reply ? Please Comment
Comments:
- Urgent
- For Review
- As Requested
- Please Reply
- Please Comment
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Comment
Comments:
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"Confidential Protected Health and Other Information Enclosed"
Protected Health Information is personal and sensitive information related to a person's health care. The other protected information may include information protected by State or Federal regulations and University policy. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Re-disclosure without additional patient consent or as permitted by law is prohibited. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to penalties described in federal and state law.
IMPORTANT WARNING: This message is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify the sender immediately and arrange for the return or destruction of these documents.
“Confidential Protected Health and Other Information Enclosed”
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