Free Pharmacy Fax Cover Sheet for Prescriptions and Orders. Download a free pharmacy fax cover sheet and send it directly from your iPhone with Send Fax Pro.
A fax cover sheet designed for pharmacies and prescribers. Includes fields for patient identifiers, prescription details, and DEA/HIPAA notices — used for prescription orders, refill authorizations, and prior authorization requests.
Key fields include: To (pharmacy or prescriber name & fax number), From (pharmacy or prescriber name, DEA #, & fax number), Patient name & DOB, Date & time, Number of pages (including cover), Rx reference / prescription number, HIPAA/DEA confidentiality notice.