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 required for prescription orders and refills.
Key fields include: Prescriber Name & DEA Number, Pharmacy Name & Fax Number, Patient Initials & Date of Birth, Rx Reference / Form Number, Total Number of Pages, HIPAA & DEA Confidentiality Notice.