Hipaa (Phi) Fax Coversheet
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1DMH Mailing Address -
Berkeley Community Mental Health Center
403 Stoney Landing Road
Moncks Corner, SC 29461
HIPAA (PHI) FAX COVERSHEET
TELEPHONE
FAX
TO:
843-761-8282
843-761-7308
FAX NO:
NO. PAGES INCLUDING THIS
TIME
FROM:
PAGE
DATE:
Urgent
For Review
Please Comment
Please Reply
Please Recycle
SUBJECT:
MESSAGE:
This Document(s) is subject to the requirements of the Federal Health Insurance
Portability and Accountability Act of 1996 ("HIPAA") and the Privacy Rule published by
the United States Department of Health and Human Services at
45 CFR §§ 160 -
164 ("Privacy Rule"). HIPAA and the Rule regulate the planned use of protected health
information and State Statue 44-22-100, all Patient Health Information (PHI) whose
commitment has been sought must be kept confidential.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS
ADDRESSED, AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND
EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THIS MESSAGE IS
NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING
THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY
DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED.
IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY
TELEPHONE, AND RETURN THE ORIGINAL MESSAGE TO US VIA U.S. POSTAL SERVICE. THANK
YOU.
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