Fax Cover Sheets
Documents:
51
This form is used for submitting a request to the American Indian Medical Home in Arizona. It serves as a cover sheet for faxing the application.
PDF 
Word
This document is a form used by the County of Los Angeles, California for transmitting Protected Health Information (PHI) via fax.
This Form is used for fax communication in Alabama.
This form is used for submitting fax cover sheets in Washington state.
