TX HHS Form H1131. Individually Identifiable Health Information Fax Transmittal

The TX HHS Form H1131: Individually Identifiable Health Information Fax Transmittal is a confidential document designed to facilitate the secure transmission of sensitive health information. This form helps solve the problem of ensuring that protected health information (PHI) is transmitted securely and only to authorized individuals.

This fax transmittal form requires specific information, including sender's and recipient's names, fax numbers, telephone numbers, agency or company name, department, date, subject, and number of pages. The form also includes instructions for the recipient, stating that they are not authorized to view the confidential information unless instructed by the sender. In situations where urgent review is necessary, this form provides a mechanism for expedited transmission.

Key features of this form include the requirement for confidentiality and the need for the recipient to contact the sender immediately if received in error. The form also includes a message section for any additional comments or replies. This document is typically used by healthcare professionals, administrators, and other authorized individuals who need to transmit sensitive health information securely.

• This form is used for transmitting individually identifiable health information via fax.
• The form requires specific information from both the sender and recipient.
• The transmission of this information is intended solely for the individual to whom it is addressed.