153 Chapter 7 Written Communication Score Date Procedure 7.6 Complete a Fax Cover Sheet Name Task: Complete a fax cover sheet clearly and accurately. Scenario: Lisa Parker, mother of Johnny Parker (DOB: 06/15/2010) requested his immunization history be sent to Anytown School, attention: Susie Payne. The school's phone number is 123-123-5784 and the fax number will be supplied by your instructor. The release of medical records has been completed and signed by Lisa, Johnny's guardian/mother. Your phone number is the main clinic number listed on the header of the fax cover sheet Equipment and Supplies: Document to be faxed (optional) Fax machine and fax number (optional) Pen Fax cover sheet (Work Product 7.1, HIPAA-Compliant Fax Cover Sheet) Standard: Complete the procedure and all critical steps with a minimum score of 85% within two attempts (or as indicated by the instructor). Scoring: Divide the points earned by the total possible points. Failure to perform a critical step, indicated by an asterisk (), results in grade no higher than an 84% (or as indicated by the instructor)