Tracking Details - #1152

Tracking Information
Case No: 1094
Order Date: 09/27/2025
Due Date:
Template Packet: HIPAA Authorization Packet
Scope:
Location: VA North Chicago
3001 Green Bay Road
North Chicago, IL 60064
Phone: None • Fax: None
Patient: Idris Elba
DOB: 03/31/1951 • SSN: ***-**-7778
VA North Chicago
3001 Green Bay Road
North Chicago, IL 60064
Phone: None • Fax: None
Idris Elba
DOB: 03/31/1951 • SSN: ***-**-7778
Requested Records
Record Status
Billing Pending
Medical Pending
File Name Uploaded Date Uploaded By
HIPAA_Authorization_1152_20250927125819.pdf 2025-09-27
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 9/27/2025 12:57 PM
Generation Dept - Printed Packet 9/27/2025 Yes 9/27/2025 4:58 PM
Fax sent 9/30/2025 Fax sent [RC:] No 9/30/2025 11:11 PM
Fax delivery confirmed 10/1/2025 Fax delivered (manual) No 10/1/2025 2:45 PM
Assigned To: 10/3/2025 Assigned To: UserNo=1006 [INITIAL] No 10/1/2025 2:45 PM
Emailed Request to Custodian Emailed Request Packet to joeperri89@gmail.com (RequestNo 2144) Yes 11/19/2025 9:42 PM
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